Erythema Multiforme Possibly Triggered by Food Substances in a Dog

Abstract

ABSTRACT. A 5-year-old female border collie presented with erythematous skin lesions at the axillae, groin, mucocutaneous junctions, and pinnae. Biopsy revealed lymphocytic interface dermatitis with hydropic degeneration of basal cells and keratinocyte apoptosis. Based on gross and histological features, diagnosis of erythema multiforme was made. The disease was resolved by treatment with azathioprine, prednisolone, and a hypoallergenic diet. Finally, the skin lesion was controlled without drug therapy but recurred easily every time commercial foods except the hypoallergenic diet were used, suggesting that food substances triggered this outbreak. KEY WORDS: canine, erythema multiforme, food substance.J. Vet. Med. Sci. 68(8): 869-871, 2006 Erythema multiforme (EM) is a rare skin disease characterized by acute self-limiting eruption in humans and animals [9]. Although pathogenesis of EM is not fully understood, it is currently hypothesized that this disease represents a cell (T lymphocyte)-mediated hypersensitivity reaction against various antigens including drugs, viruses, or bacteria [1,3,4,[6][7][8][9]. Elimination of the trigger factors is important in treatment of EM, but in more than 20% of canine EM cases these factors cannot be identified [7]. In this report, we describe a dog with EM thought to have been triggered by food substances.A 5-year-old female border collie weighing 23.5 kg presented with a 3-week course of skin disease. The owner first noticed eruption at the axillae for which antibiotic therapy was recommended, but the lesion gradually expanded. The dog had no history of recent drug administration or changes in diet before onset of the disease.At presentation, the dog was active and had a good appetite. Rectal temperature was 39.4°C. Irregular-shaped erythemas without hair loss were present on bilateral axillae and erythematous patches were sparsely observed on the groin area. Examination of the oral cavity showed no significant lesions on the gingival mucosa. Mild erosions with crusts were noticed on the eyelids, pinnae, lip margins, and perianal area. These skin lesions were not pruritic or painful. No other abnormalities were noticed on physical examination. Blood and plasma biochemical profile results were normal except for elevated alkaline phosphatase (509 IU/L) and creatine kinase levels (461 IU/L).Skin biopsies obtained from the lip margin, axillae, and vagina revealed lymphocytic interface dermatitis with hydropic degeneration of basal cells and intracellular edema (Fig. 1). Single apoptosis of keratinocytes was randomly observed in all layers of the epidermis (Fig. 2). Exocytosis of lymphocytes was evident, occasionally surrounding the apoptotic keratinocytes called as satellitosis of lymphocytes. Based on the gross and histological findings, a final diagnosis of EM was made.Since no trigger was discovered, the dog was treated with prednisolone (1.8 mg/kg, bid) for 3 weeks. The lesions near the mucocutaneous junctions and pinnae resolved, but those at the axillae and groin remained...

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