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Localised erythema multiforme-like reaction confined to a region of clipper burn in a dog 一例犬电剪灼烧区域的局部多形红斑样反应 作者：Heng L. Tham , Otto I. Lanz and Keith E. Linder
翻译：王帆
Localised erythema multiforme (LEM) is only reported to occur in humans and not in domestic species. This case report describes the clinical and histopathological features of LEM-like reaction in a dog, confined to a region of clipper burn.
摘要–局部多形红斑 (LEM) 仅发生于人类，而家养动物未见报道。本病例报告描述了犬 LEM 样反应的临床和组织病理学特征，病变局限于电剪灼烧区域。
Introduction 介绍 Erythema multiforme (EM) is an immune-mediated dermatosis caused by lymphocyte-mediated apoptosis of keratinocytes, and is reported in humans, dogs, cats and horses.In people, EM is associated primarily with Herpes simplex virus, occasionally Mycoplasma pneumoniae and much less often drugs. However, in dogs, limited data are available on the cause of EM, yet cases have been temporally associated with drugs, commercial dog foods and neutraceuticals.Localised EM (LEM), a condition in which EM-like skin lesions develop only in a confined body region, was first reported in humans in 1982. Since then, there have been numerous case reports of LEM or LEM-like dermatoses in humans. We describe a dog with a LEM-like clinical presentation confined to a region of clipper burn. 多形红斑(EM)是一种由淋巴细胞介导的角质形成细胞凋亡的免疫介导性皮肤病，在人类、犬、猫和马中均有报道。在人类中，EM主要与单纯疱疹病毒有关，偶尔与肺炎支原体有关，很少与药物有关。然而，在犬上，关于EM病因的数据有限，但病例暂时与药物、商业犬粮和保健品有关。局部EM (LEM)是一种仅在机体局部区域发生EM样皮肤病变的疾病，自1982年首次在人类中报道以来，已有大量关于人类LEM或EM样皮肤病的病例报道。我们描述了一例犬电剪灼烧区域出现LEM样临床表现的病例。
Case report 病例报告 An 8-year-old mixed breed dog presented to the surgical department for surgical repair of a ruptured, right, cranial cruciate ligament. One year previously, the dog had the same procedure performed on the left leg and has been receiving carprofen (2.2 mg/kg, Zoetis; Kalamazoo, MI, USA) daily until presentation. Using a size 40 clipper blade, the hair was clipped from the right hip region and distally to the right hock region. During this procedure, a clipper burn developed only over the region of the right hip. Subsequent routine aseptic skin preparation followed, which included alternating scrubs of povidone iodine (7.5% iodine) and isopropyl alcohol (70%) for a total of three times each, before a final iodine solution (10% iodine) was used. Intravenous cefazolin (22 mg/kg, Hikma Farmaceutica; Sintra, Portugal), subcutaneous morphine sulfate (0.25 mg/kg, Hospira; Lake Forest, IL, USA) and subcutaneous carprofen (2.2 mg/kg, Zoetis; Kalamazoo, MI, USA) were administered pre-operatively. The surgery was successful and the dog was discharged the following day with codeine sulfate (1 mg/kg, WestWard; Eatontown, NJ, USA) and carprofen (2.2 mg/kg, Zoetis; Kalamazoo, MI, USA). 一只8岁的杂交犬进行外科手术修复右腿断裂的前十字韧带。一年前，这只犬左腿进行了相同的手术，并一直服用卡洛芬(2.2 mg/kg, 硕腾)，每日一次，直到现在。使用40号刀头电剪，从右腿髋关节区域至右腿远端飞节区域进行剃毛。剃毛时，电剪仅灼烧了右腿髋关节区域。随后进行常规无菌备毛准备，包括用聚维酮碘(7.5%碘)和异丙醇(70%碘)交替刷洗三次，最后使用碘溶液(10%碘)。术前静脉注射头孢唑啉(22 mg/kg)，皮下注射硫酸吗啡(0.25 mg/kg)和皮下注射卡洛芬(2.2 mg/kg)。成功进行手术，次日给予硫酸可待因(1 mg/kg)和卡洛芬(2.2 mg/kg)，患犬出院。
Five days post-surgery, new skin lesions developed on the right hip and were localised only to the skin area that developed the clipper burn. No additional drug treatments were given after surgery. On dermatological examination, the lesions were multifocal, palpably raised annular to polycyclic and “targetoid-like”. Some of these lesions had a central erosion or shallow ulcer, whereas others had a central crust. There were a few palpably raised annular lesions with hair and clinically normal skin in the centre (Figure 1). These lesions were neither pruritic nor painful. The adjacent region without a clipper burn that also was clipped and aseptically prepared, appeared clinically normal. Other than the skin lesions, the dog was otherwise clinically healthy with no lesions in other sites such as mucosae, mucocutaneous junctions, ear canals and foot pads. 术后5天，右侧髋关节出现新的皮肤病变，且仅局限于电剪灼烧的皮肤区域。术后未给予其他药物治疗。在皮肤科检查，病变呈多灶性，明显凸起环状到多环状和“靶样”病变。一些病变中央有糜烂或浅溃疡，而另一些病变中央有结痂。可见少数明显凸起的环形病变，中间有毛发和临床外观正常的皮肤(图1)。这些病变既无瘙痒也无疼痛。没有电剪灼烧的相邻区域，也进行了剃毛和无菌备毛准备，临床表现正常。除皮肤病变外，犬临床表现健康，其他部位如粘膜、皮肤粘膜区域、耳道和爪垫均无病变。
Biopsies were collected from the margins of newer, polycyclic skin lesions. Histologically, a cell-rich, lymphocytic interface dermatitis occurred with keratinocyte apoptosis and lymphocytic satellitosis at all epidermal levels (Figure 2). Based on the skin lesion types, localised nature of the skin lesions and histopathological findings, a diagnosis of LEM-like reaction confined to a region of clipper burn was made. 对较新的多环性皮肤病变的边缘进行活检。组织学检查表现为细胞量丰富的淋巴细胞界面性皮炎，所有表皮层出现角质形成细胞凋亡和淋巴细胞卫星现象(图2)。基于皮肤病变类型,局部皮肤病变的性质和组织病理学发现,诊断为电剪灼烧区域的LEM样反应。
All skin lesions spontaneously resolved completely without any treatment 12 weeks after initial onset. Four months after complete resolution was achieved, the owner reported no further development of skin, mucocutaneous or mucosal lesions, the skin lesions were still in clinical remission, and there was full hair regrowth despite the dog being treated continuously with carprofen (2.2 mg/kg, Zoetis; Kalamazoo, MI, USA). 所有皮肤病变在发病12周后自行痊愈，无需任何治疗。完全康复4个月后，宠主报告没有出现皮肤、皮肤粘膜区域或粘膜病变，皮肤病变仍处于临床缓解状态，虽然患犬在持续使用卡洛芬(2.2 mg/kg)，但毛发已全部生长。
Discussion 讨论 The authors describe a case of LEM-like reaction in a dog confined to an area of clipper burn only. Erythema multiforme in humans usually is bilateral and predominantly has an acral and facial distribution. Localised EM in humans is uncommon and has been confined to the site of a radiation port, a sequela to anthrax vaccination, and contact sites with rubber gloves and knee brace. In dogs, skin lesions of EM typically are more generalised and bilateral, and LEM has not been reported. Possible triggers in this case include drug or infection (i.e. pyoderma). Cefazolin may be a trigger because the dog had received a previous dose one year previously. Carprofen is less likely to be the trigger because the dog had continued to receive carprofen while lesions spontaneously resolved. Morphine sulfate has not been reported to be associated with drug-induced EM. While drug-induced EM is typically symmetrical and/or generalised, an atypical drug-induced EM leading to localised skin lesions cannot be excluded here. Infections are well-recognised in humans to cause EM, yet this mechanism is not established in dogs. 作者描述了一例仅发生在电剪灼烧区域的LEM样反应的患犬。人类的多形红斑通常是双侧的，主要分布在肢端和面部。局部EM在人类中并不常见，仅限于辐射部位、炭疽疫苗接种的并发症以及使用橡胶手套和护膝的接触部位。在犬中，EM的皮肤病变通常更为全身和双侧，而LEM尚未见报道。本病例，可能的诱因包括药物或感染(例：脓皮病)。头孢唑啉可能是一种诱因，因为犬在一年前使用过。卡洛芬是不太可能的诱因，因为犬持续使用卡洛芬，而病变自行缓解。与硫酸吗啡相关的药物诱导EM没有相关报道。虽然药物诱导的EM通常是对称的和/或全身性的，但非典型的药物诱导的EM导致局部皮肤病变在本案例不能排除。感染在人类中很容易引起EM，但这种机制在犬中未见。
Alternatively, the LEM-like reaction in this dog may be associated with a T-cell-mediated keratinocyte apoptosis, secondary to allergic contact dermatitis (ACD) to povidone-iodine. Studies show that sensitised cytotoxic T cells kill keratinocytes which expressed protein that were modified by haptens. There is one case report of erythema multiforme-like skin eruptions due to ACD secondary to povidone iodine in a human. The dog in this case report did undergo a surgery to repair the left cranial cruciate ligament one year previously and at that time, sensitisation to povidone-iodine (afferent phase) may have occurred during the routine aseptic skin preparation. 另外，这只犬的LEM样反应可能与T细胞介导的角质形成细胞凋亡有关，继发于聚维酮碘导致的接触性过敏性皮炎(ACD)。研究表明，致敏的细胞毒型T细胞可以杀死具有被半抗原修饰的表达蛋白的角质形成细胞。在人类有一个病例，报告了由于ACD继发于聚维酮碘，出现了多形红斑样皮疹。本病例报告中的犬确实在一年前接受了左腿前十字韧带修复手术，当时，在常规无菌备皮过程中可能发生了聚维酮碘(传入期)致敏作用。
In conclusion, the authors report a case of LEM-like reaction confined to a region of clipper burn in a dog. The pathogenesis remains unknown yet the prognosis can be considered good as the lesions resolved spontaneously without treatment. 总之，作者报告了一例局限于电剪灼烧区域的LEM样反应患犬。其发病机制尚不清楚，但预后良好，无需治疗即可自行痊愈。
Figure 1. Gross skin lesions in a dog with localised erythema multiforme-like reaction. Skin lesions were localised to the right hip region (a). A closer view reveals palpable raised annular to polycyclic lesions (b). 图1。一只伴有局部多形红斑样反应的犬皮肤病变整体表现。皮肤病变局限于右侧髋关节区域(a)。近距离观察显示明显的环状凸起至多环状病变(b)。
Figure 2. Histopathological findings of localised erythema multiforme-like reaction in a mixed-breed dog. A cell-rich lymphocytic interface dermatitis is characterised by prominent lymphocytic infiltration of the superficial dermis and epidermis by lymphocytes in association with apoptosis of keratinocytes (arrows) at all epidermal levels. Lymphocytes satellite several of the apoptotic keratinocytes. Haematoxylin and eosin, *40. 图2。一只杂交犬的局部多形红斑样反应的组织病理学检查。细胞量丰富的淋巴细胞界面性皮炎，其特征是淋巴细胞浸润浅表真皮层和表皮层，并伴有角质形成细胞凋亡(箭头所示)。数个凋亡的角质形成细胞周围有淋巴细胞卫星现象。苏木素和伊红，40倍放大。
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发表于 2022-2-8 10:23:53
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