Pemphigus foliaceus‐like drug reaction in a 3‐month‐old crossbreed dog treated for juvenile cellulitis

Abstract

Two weeks after administration of routine vaccinations, a 3-month-old, male crossbreed dog developed cutaneous lesions that were clinically and histopathologically consistent with a diagnosis of juvenile cellulitis. The patient was treated with systemic antibacterial, antibacterial ophthalmic ointment and nonsteroidal anti-inflammatory drugs. Within 1 week, new skin lesions that were clinically, histopathologically and immunohistochemically consistent with pemphigus foliaceus developed. The latter completely resolved following drug withdrawal, suggesting a pemphigus foliaceus-like drug reaction. However, the initial lesions persisted and required glucocorticoid therapy to effect resolution. To the authors' knowledge, this is the first reported case of a puppy developing juvenile cellulitis followed by a pemphigus foliaceus-like reaction shortly thereafter, in response to drug therapy.

Drug Hypersensitivity Reactions Targeting the Skin in Dogs and Cats

“…These terms apply when the drug reaction mimics naturally occurring pemphigus foliaceus . Pemphigus foliaceus‐like drug reaction resolves once the offending drug is discontinued (“drug‐induced pemphigus”) .…”

“…These cases involved trimethoprim‐sulfamethoxypyridazine, trimethoprim‐sulfamethoxazole, cephalexin, and oxacillin. Another puppy that was treated for juvenile cellulitis with amoxicillin‐clavulanic acid and topical oxytetracycline developed clinical signs consistent with pemphigus foliaceus . After discontinuation of all medications, the clinical signs resolved, and a diagnosis of pemphigus foliaceus‐like drug reaction was made.…”

Fipronil–amitraz–S‐methoprene‐triggered pemphigus foliaceus in 21 dogs: clinical, histological and immunological characteristics

“…While the genetic background plays an important role, one or more exogenous factors have been proposed to trigger this disease . Of the possible external factors, drugs are the best‐recognized triggers of pemphigus in humans, and they are the most frequently proposed triggers in reports of canine PF . In veterinary clinical settings, however, a systematic approach to determine the cause of a drug reaction (e.g.…”

“…6 Of the possible external factors, drugs are the best-recognized triggers of pemphigus in humans, 7 and they are the most frequently proposed triggers in reports of canine PF. [8][9][10][11][12] In veterinary clinical settings, however, a systematic approach to determine the cause of a drug reaction (e.g. the use of the Naranjo drug probability scale) is rarely implemented and, therefore, most reported cases of drug-triggered canine PF remain unsubstantiated.…”

Letter to the Editor

“…We read with interest the recent article by Drs Horvath et al . on a pemphigus foliaceus‐like drug reaction in a dog 1 . They state on page 357 that amoxycillin and clavulanic acid have not been implicated in canine cutaneous adverse drug reactions.…”