Systemic protothecosis was diagnosed in 17 Australian dogs between 1988 and 2005. There was a preponderance of young-adult (median 4 years), medium- to large-breed dogs. Females (12/17 cases) and Boxer dogs (7 cases, including 6 purebreds and one Boxer cross) were over-represented. Sixteen of 17 dogs died, with a median survival of four months. A disproportionate number of cases were from coastal Queensland. In most patients, first signs were referable to colitis (11/17 cases), which varied in severity, and was often present for many months before other symptoms developed. Subsequent to dissemination, signs were mostly ocular (12 cases) and/or neurologic (8 cases). Two dogs had signs due to bony lesions. Once dissemination was evident, death or euthanasia transpired quickly. Prototheca organisms had a tropism for the eye, central nervous system (CNS), bone, kidneys and myocardium, tissues with a good blood supply. Microscopic examination and culture of urine (5 cases), cerebrospinal fluid (CSF;1 case), rectal scrapings (4 cases), aspirates or biopsies of eyes (5 cases) and histology of colonic biopsies (6 cases) as well as skin and lymph nodes (2 cases) helped secure a diagnosis. Of the cases where culture was successful, P wickerhamii was isolated from two patients, while P zopfii was isolated from five. P zopfii infections had a more aggressive course. Treatment was not attempted in most cases. Combination therapy with amphotericin B and itraconazole proved effective in two cases, although in one of these treatment should have been for a longer duration. One surviving dog is currently still receiving itraconazole. Protothecosis should be considered in all dogs with refractory colitis, especially in female Boxers.

Hallopeau with IL-23 blockers -two new casesDear Editors, Acrodermatitis continua of Hallopeau (ACH) is a very rare inflammatory, often chronic pustular skin and nail bed disease of the distal phalanges, which can result in permanent anonychia and disfigurement of the distal phalanges. It remains controversial whether ACH is a localized form of pustular psoriasis or a separate entity [1]. For systemic therapy, only retinoids are licensed for ACH under the indication of pustular psoriasis of hands and feet. However, as psoriasis vulgaris (PsO) and psoriatic arthritis (PsA) are often comorbid diseases in ACH patients, there is experience in ACH with drugs that are standard therapies for PsO or PsA, and these therapies have also been used in an off-label setting in ACH patients without these comorbidities [2].In a review of 35 patients with ACH treated with biologicals also used in PsO, a good response was observed [3]. On the other hand, a multicenter case series of 39 consecutive Clinical LetterTable 1 Characteristics of ACH patients and treatment characteristics with IL-23 antagonists. New cases Follow up of already reported patients a Case 1 Case 2 Case 3 a Case 4 a Sex Female Male Male Female Age (years) b 60 67 61 71 Age at onset of ACH (years) 58 42 55 43 Clinical extent Both hands and feet Left hand and both feet Both hands and feet Both hands and one foot Family history of pustular psoriasis

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Age-related macula degeneration (AMD) is accompanied by considerable consequences regarding the psychosocial quality of life. A considerable body of research literature now indicates, for instance, an increased rate of depression and substantial loss of everyday capabilities in AMD patients. However, inter-individual differences are large and part of the explanation lies in differences in the ability to cope with and detach oneself from aims in life. The negative impact of AMD on the qualify of life is associated with a need for psychosocial support, but this need is barely met at present. A series of studies nevertheless supports the view that successful intervention is possible even with very old patients. In this respect the problems at present have less to do with recognition than with application and implementation.