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Dermatophytosis and papular eosinophilic/mastocytic dermatitis (urticaria pigmentosa-like dermatitis) in three Devon Rex cats 3只德文卷毛猫的皮肤癣菌病和丘疹性嗜酸性细胞/肥大细胞性皮炎(色素样荨麻疹性皮炎) 作者：Silvia Colombo；Fabia Scarampella；Laura Ordeix ；Paola Roccabianca 翻译：王帆 Presenting signs: Three Devon Rex cats were presented with multiple erythematous papules, occasionally associated with crusting and hyperpigmentation, with a linear distribution on the head, neck, chest and abdomen. One cat also had multifocal alopecia with hyperpigmentation on the dorsum. 症状表现:三只德文卷毛猫出现多发性皮肤红斑丘疹，偶见结痂和色素沉着，呈线性分布于头部、颈部、胸部和腹部。一只猫也有多灶性脱毛，伴有背部色素沉着。 Diagnosis and treatment: Clinical and histopathological features were suggestive of papular eosinophilic/mastocytic dermatitis (urticaria pigmentosa-like dermatitis). In all cases, dermatophytosis was diagnosed: in cases 1 and 2 there was histopathological evidence of dermatophytosis, while fungal culture was positive for Microsporum canis in cases 2 and 3. In all cats, lesions disappeared following antifungal treatment. 诊断和治疗:临床和组织病理学特征提示为丘疹性嗜酸性细胞/肥大细胞性皮炎(色素样荨麻疹性皮炎)。所有病例均诊断为皮肤癣菌病:病例1和2有皮肤癣菌病的组织病理学证据，而病例2和3的真菌培养为犬小孢子菌阳性。所有猫接受抗真菌治疗后病变消失。 Clinical significance: Papular eosinophilic/mastocytic dermatitis in Devon Rex cats may represent either an atypical presentation of dermatophytosis or a clinical and histological reaction pattern to various diseases, including dermatophytosis and allergic diseases. Clinical differentiation is crucial as there are important implications regarding treatment and, in particular, the use of glucocorticoids, which are contraindicated in cases of dermatophytosis. 临床意义:德文卷毛猫的丘疹性嗜酸性细胞/肥大细胞性皮炎可能是皮肤癣菌病的非典型表现，也可能是对各种疾病的临床和组织学反应，包括皮肤癣菌病和过敏性疾病。临床鉴别诊断是至关重要的，因为这对治疗有重要意义，特别是有关糖皮质激素的使用，这是皮肤癣菌病的禁忌。 Dermatophytosis is a contagious superficial fungal infection of the stratum corneum, hair and nails most often caused, in the cat, by Microsporum canis. Feline dermatophytosis has a plethora of clinical presentations ranging from focal or multifocal alopecia with scaling and minimal inflammation to more inflammatory lesions characterised by erythema, scaling, crusting and follicular papules, miliary dermatitis, exfoliative generalised dermatitis, otitis externa, chin acne, tail seborrhoea, pseudomycetoma and onychomycosis. An unusual presentation of dermatophytosis with hyperpigmented lesions has been described in a young Devon Rex cat. 皮肤癣菌病是一种猫传染性常由犬小孢子菌导致的皮肤角质层、毛发和指甲的浅表真菌感染。猫皮肤癣菌病有多种临床表现，从局灶性或多灶性脱毛伴有皮屑和轻微炎性反应，到以皮肤红斑、皮屑、结痂和毛囊性丘疹、粟粒性皮炎、表皮剥脱性全身性皮炎、外耳炎、下巴痤疮、尾部皮脂溢、假足菌肿和甲癣病为特征的多处炎性病变。一种不常见的皮肤癣菌病伴有色素沉着的病变，已经在一只年轻的德文卷毛猫上有描述。
Papular eosinophilic/mastocytic dermatitis (urticaria pigmentosa-like dermatitis), a condition reported in 2004 in five Devon Rex cats, is clinically characterised by a maculopapular, often hyperpigmented and/or crusted, cutaneous eruption. Histopathological examination reveals a perivascular to diffuse mastocytic and eosinophilic infiltrate in the dermis. These features are similar, although not identical, to a condition called feline urticaria pigmentosa, which was reported in 1996 in three related Sphynx cats and histopathologically characterised by a perivascular to diffuse dermal and subcutaneous infiltrate of well-differentiated mast cells. The Devon Rex and Sphynx breeds are genetically related and have recently been shown to share a mutation of the KRT71 (Keratin 71) gene. Both diseases have been compared with human cutaneous indolent mastocytosis, also known as urticaria pigmentosa, which occurs mainly in children. However, the two feline conditions are not identical and it is not clear whether they both represent analogues of human urticaria pigmentosa. In Devon Rex cats, it has been suggested that papular eosinophilic/mastocytic dermatitis could represent a reaction pattern, similar to miliary dermatitis or eosinophilic granuloma, specific to the breed. 丘疹性嗜酸性细胞/肥大细胞性皮炎(色素样荨麻疹性皮炎)，一种在2004年报道过的5只德文卷毛猫的表现，临床特征为斑丘疹性，通常有色素沉着和/或结痂的突发性皮肤病变。组织病理学检查显示真皮层血管周弥漫性肥大细胞和嗜酸性细胞浸润。这些特征虽然不完全相同，但与猫色素性荨麻疹相似，在1996年在三只有关系的斯芬克斯猫上有过报道，其组织病理学特征为真皮层和皮下组织血管周有分化良好的肥大细胞弥散性浸润。德文卷毛猫和斯芬克斯猫有遗传相关性，而且它们都有KRT71(角蛋白71)基因的突变。将两品种疾病与主要发生在儿童身上的人皮肤无痛性肥大细胞增多症(又称色素性荨麻疹)进行对比。然而，这两品种猫的疾病并不完全相同，目前还不清楚它们是否都与人的色素性荨麻疹相似。在德文卷毛猫中，认为丘疹性嗜酸性细胞/肥大细胞性皮炎可能代表一种反应模式，类似于粟粒性皮炎或嗜酸性肉芽肿，是该品种特有的表现。
This report describes three cases of dermatophytosis with clinical and histopathological features suggestive of papular eosinophilic/ mastocytic dermatitis in Devon Rex cats. 本文报告三例德文卷毛猫的皮肤癣菌病的临床和组织病理学特征提示丘疹性嗜酸性细胞/肥大细胞性皮炎。
Clinical reports 临床报告 Case 1 病例1 A 7-month-old female Devon Rex cat was presented with a 2-week history of non-pruritic skin disease. The cutaneous lesions were noticed approximately 3 weeks after discontinuation of a 4-week course of itraconazole (Sporanox; JanssenCilag) administered by the referring veterinarian for suspected dermatophytosis in a housemate cat. The cat lived indoors with four other cats and three dogs, was fed a commercial dry food and homecooked fish or turkey, was regularly vaccinated and on ectoparasite prevention with selamectin spot-on once monthly(Stronghold; Pfizer). 一只7个月大的雌性德文卷毛猫有2周的非瘙痒性皮肤病病史表现。转诊兽医因怀疑同屋猫有皮肤癣菌病给予伊曲康唑(斯皮仁诺；杨森药厂)治疗4周，停药后大约3周后发现皮肤病变。这只猫与其他四只猫和三只犬在室内居住，饲喂商品化干粮和自制鱼肉或火鸡肉，定期接种疫苗，并每月使用一次塞拉菌素滴剂预防体外寄生虫病。
On general physical examination, the cat was healthy with abnormalities restricted to the skin.Dermatological examination revealed multiple erythematous papules, some of which had a crusted and hyperpigmented surface, located on the head, neck, chest and abdomen (Figure 1). Differential diagnoses included papular eosinophilic/mastocytic dermatitis (urticaria pigmentosa like-dermatitis), feline atopic dermatitis, adverse food reaction, flea bite hypersensitivity, dermatophytosis and viral plaques. 在全身体格检查中，患猫除皮肤病变外体格健康。皮肤病学检查发现多灶性皮肤红斑性丘疹,其中一些表面有结痂和色素沉着,位于头部、颈部、胸部和腹部(图1),鉴别诊断包括丘疹性嗜酸性细胞/肥大细胞性皮炎(色素样荨麻疹性皮炎)、猫特应性皮炎、食物副反应、跳蚤叮咬性过敏症、皮肤癣菌病和病毒性斑块。 Figure 1 Erythematous crusted lesions on the ventral chest of case 1 图1 病例1胸部腹侧的红斑性结痂病变
Wood’s lamp examination and microscopic examination of plucked hair were negative and cytological examination of material obtained from the papules showed a neutrophilic inflammatory infiltrate with moderate numbers of macrophages and eosinophils. Due to the clinical presentation being strongly suggestive of papular eosinophilic/mastocytic dermatitis, multiple 6 mm punch biopsies were taken. Specimens were fixed in 10% buffered formalin and stained with haematoxylin and eosin (H&E) and periodic acid Schiff (PAS). Histopathological examination revealed epidermal and infundibular hyperplasia with epidermal hypermelanosis and interstitial to diffuse dermatitis characterised by a prevalence of mast cells and eosinophils. Microscopic examination showed a few fungal spores in just a single follicular infundibulum (Figure 2). Spores were only detected after performing several microscopic sections. 伍德氏灯检查和拔毛显微镜检查均为阴性，从丘疹采样的细胞学检查显示中性粒细胞炎性反应，伴有中度的巨噬细胞和嗜酸性细胞浸润。由于临床表现高度提示丘疹性嗜酸性细胞/肥大细胞性皮炎，进行了多处6毫米皮肤打孔活检采样。样本固定在10%福尔马林缓冲液中，进行苏木精-伊红染色(H&E)和碘酸雪夫式(PAS)染色。组织病理学检查显示表皮层和毛囊漏斗部增生，伴表皮层色素沉着和肥大细胞和嗜酸性细胞弥散性浸润皮炎表现。显微镜检查显示，只有一个毛囊漏斗部中有少量真菌孢子(图2)。对切片经过多次镜检，才检测到孢子。 Figure 2 Fungal arthrospores within a follicular infundibulum (arrow) in case 1. Surrounding the infundibulum, with a perivascular to interstitial distribution, a mixed population of inflammatory cells is evident. Nondegenerate neutrophils and small mature lymphocytes are prevalent, with fewer numbers of macrophages and occasional plasma cells. The follicular infundibulum is characterised by minimal mural infiltration by small mature lymphocytes (arrowheads). Haematoxylin and eosin (H&E), bar = 27 μm 图2病例1中一个毛囊漏斗部内的真菌节孢子（箭）。在漏斗部周围，有大量明显的混合炎性细胞浸润分布。普遍为非退行性中性粒细胞和小的成熟型淋巴细胞，巨噬细胞较少，偶尔可见浆细胞。毛囊漏斗部的特征是轻微毛囊壁有小的成熟型淋巴细胞浸润(箭头)。苏木精-伊红染色(H&E)，标尺=27μm
Other features seen in case 1 included follicular keratosis, neutrophilic exocytosis, lymphocytic mural folliculitis and deep perivascular lymphoplasmacytic dermatitis. The final diagnosis was dermatophytosis. 病例1的其他特征包括毛囊角化症、中性粒细胞细胞外排、淋巴细胞性毛囊壁毛囊炎和皮肤深层血管周淋巴浆细胞性皮炎。最终诊断为皮肤癣菌病。
The cat showed a complete clinical response to itraconazole given at 5 mg/kg orally q24h for 4 weeks, and was negative on fungal culture at the end of the treatment. All the in-contact animals received the same systemic treatment. Topical therapy and environmental decontamination, as well as a second fungal culture to be performed a few weeks after stopping the treatment, although strongly advised, were all declined by the owner. 患猫使用5 mg/kg口服伊曲康唑，每24小时一次，连续4周治疗后有明显临床治疗效果，治疗结束时真菌培养呈阴性。所有接触的动物都接受同样的全身治疗。尽管强烈建议进行外部治疗和环境净化，并建议停止治疗几周后，再次进行真菌培养，但都遭到了主人的拒绝。
Case 2 病例2 A10-month-old male Devon Rex cat was presented with a 2-week history of non-pruritic skin disease. The cat had been treated by the referring veterinarian for suspected superficial pyoderma with amoxicillin and clavulanic acid (Synulox; Pfizer) for 11 days, but this produced no improvement. The cat lived indoors with seven other cats, was fed commercial dry and canned food, was regularly vaccinated and on ectoparasite prevention with selamectin spot-on once monthly. 一只10个月大的雄性德文卷毛猫，有2周的非瘙痒性皮肤病病史表现。转诊兽医怀疑有浅表脓皮病，曾给患猫使用阿莫西林克拉维酸(速诺;辉瑞公司)治疗11天，但没有效果。患猫与其他七只猫在室内居住，饲喂商品化干粮和罐装食品，定期接种疫苗，每月使用一次塞拉菌素滴剂预防体外寄生虫病。
General physical examination was unrewarding, with abnormalities restricted to the skin. Dermatological examination revealed multiple erythematous papules, some of which had a crusted and hyperpigmented surface, located on the chest and in the groin. The papules on the chest had a linear distribution (Figure 3) and erythema involving the medial aspect of both front legs was also observed. Differential diagnoses included papular eosinophilic/mastocytic dermatitis (urticaria pigmentosa-like dermatitis), feline atopic dermatitis, adverse food reaction, flea bite hypersensitivity, dermatophytosis and viral plaques. 全身体格检查除皮肤病变外未见异常。皮肤病学检查发现位于胸部和腹股沟处有多灶性红斑性丘疹，其中一些表面有结痂和色素沉着。胸部丘疹呈线性分布(图3)，两前肢内侧可见红斑。鉴别诊断包括丘疹性嗜酸性细胞/肥大细胞性皮炎(色素样荨麻疹性皮炎)、猫特应性皮炎、食物副反应、跳蚤叮咬性过敏症、皮肤癣菌病和病毒性斑块。 Figure 3 Multiple erythematous papules with a linear distribution on the lateral chest of case 2 图3病例2胸部外侧呈线形分布的多处红斑性丘疹。
Wood’s lamp examination and microscopic examination of plucked hair were negative, while fungal culture performed by toothbrush technique was positive for M canis. Due to the clinical presentation, which was strongly suggestive of papular eosinophilic/ mastocytic dermatitis, the significance of a positive fungal culture was considered questionable, and a possible consequence of environmental contamination. Multiple 6 mm punch biopsies were taken and specimens were fixed in 10% buffered formalin and stained with H&E and PAS.Histopathological examination revealed epidermal and infundibular hyperplasia with epidermal hypermelanosis and interstitial to diffuse dermatitis characterised by an abundance of mast cells and eosinophils. Microscopic examination also showed a few fungal spores in only one follicular infundibulum.The final diagnosis was dermatophytosis. 伍德氏灯检查和拔毛显微镜检查均为阴性，牙刷技术真菌培养为犬小孢子菌阳性。由于临床表现高度提示丘疹性嗜酸性细胞/肥大细胞性皮炎，认为真菌培养阳性可疑，可能是环境污染的结果。进行多处6毫米皮肤打孔活检采样，样本固定在10%福尔马林缓冲液中，进行H&E和PAS染色。组织病理学检查显示表皮层和毛囊漏斗部增生，伴表皮色素沉着和大量肥大细胞和嗜酸性细胞浸润性弥散性皮炎。显微镜检查也发现只有一个毛囊漏斗部中有少量真菌孢子。最终诊断为皮肤癣菌病。
The cat showed a complete clinical response to itraconazole, which was given at 5 mg/kg orally q24h for 4 weeks, and was negative on fungal culture at the end of the treatment. A second fungal culture, to be performed a few weeks after stopping the treatment, was declined by the owner. Topical therapy and environmental decontamination, although strongly advised, were also declined by the owner. The cat relapsed after participating in a cat show and showed a favourable clinical response when treated again with the same therapeutic protocol. 患猫使用5 mg/kg口服伊曲康唑每24小时一次，连续4周治疗，有明显临床效果，治疗结束时真菌培养结果为阴性。在停止治疗几周后，主人拒绝了第二次真菌培养。尽管强烈建议进行外部治疗和环境净化，但主人也拒绝了。患猫在参加猫展后复发，当再次使用相同治疗方案治疗时，表现出良好的临床治疗效果。
Case 3 病例3 A 1-year-old male neutered Devon Rex cat was presented with a 5-month history of moderately pruritic skin disease. The cat had been previously treated with a topical product containing thiabendazole, neomycin and dexamethasone (Tresaderm; Merial) with no improvement. The cat was housed indoors with no other pets, regularly vaccinated, fed a commercial dry food and on ectoparasite prevention with selamectin spot-on once monthly. 一只1岁的雄性已去势德文卷毛猫，有5个月的中度瘙痒性皮肤病病史表现。该猫曾用含有噻苯达唑、新霉素和地塞米松(特瑞沙得明;Merial)的外部治疗产品治疗无效。患猫室内居住，无其他同居动物，定期接种疫苗，饲喂商品化干粮，每月使用一次塞拉菌素滴剂进行体外寄生虫预防。
On physical examination, the cat was healthy with abnormalities restricted to the skin. Dermatological examination revealed multiple coalescing, hyperpigmented areas of alopecia involving the whole dorsum and the tail (Figure 4), and multiple erythematous papules with a linear distribution on the ventral chest (Figure 5). Differential diagnoses included dermatophytosis, demodicosis, papular eosinophilic/mastocytic dermatitis (urticaria pigmentosa-like dermatitis), feline atopic dermatitis, adverse food reaction and flea bite hypersensitivity. 在体格检查中，患猫除皮肤病变未见异常。皮肤病学检查发现多灶性合并的色素沉着的脱毛区域，位于整个背部和尾部(图4),且胸部腹侧多处红斑性丘疹呈线性分布(图5)。鉴别诊断包括皮肤癣菌病、蠕形螨病、丘疹性嗜酸性细胞/肥大细胞性皮炎(色素样荨麻疹性皮炎)、猫特应性皮炎、食物副反应和跳蚤叮咬性过敏症。 Figure 4 Multiple coalescing, hyperpigmented areas of alopecia involving the dorsum of case 3 图4病例3背部多处合并的色素沉着的脱毛区
Figure 5 Multiple erythematous papules with a linear distribution on the ventral chest of case 3 图5病例3胸部腹侧线状分布的多处红斑性丘疹
Multiple deep skin scrapings were negative for Demodex mites, and cytological tape strip examination revealed only a few corneocytes. Wood’s lamp examination and microscopic examination of plucked hair were also negative, and hair samples for fungal culture were collected by toothbrush technique from the whole body. Multiple 6 mm punch biopsies were taken from the papular lesions on the ventral chest and from one alopecic area on the dorsum, fixed in 10% buffered formalin and stained with H&E and PAS. 多次皮肤深刮寻找蠕形螨呈阴性，透明胶带细胞学检查仅发现少量角化细胞。伍德氏灯检查和拔毛显微镜检查均为阴性，用牙刷技术全身采集毛发真菌培养。从胸部腹侧的丘疹病变和背部一处脱毛区，进行多处6毫米皮肤打孔活检采样，用10%福尔马林缓冲液固定，用H&E和PAS染色。
Histopathological examination revealed moderate epidermal hyperplasia and hyperkeratosis with focal parakeratosis and diffuse interstitial eosinophilic and mastocytic dermatitis (Figure 6).These features were consistent with a diagnosis of papular eosinophilic/mastocytic dermatitis. Fungal culture was positive for M canis and, following this result, the pathologist was asked to re-examine the slides and cut additional sections in order to demonstrate or exclude the presence of dermatophytes. Multiple PAS stained sections were examined, but no fungal elements could be observed.The final diagnosis in case 3 was dermatophytosis and papular eosinophilic/mastocytic dermatitis. 组织病理学检查显示:表皮层中度增生和角化过度伴局灶性角化不全，嗜酸性细胞和肥大细胞弥散性浸润性皮炎(图6)。这些特征符合丘疹性嗜酸性细胞/肥大细胞性皮炎的诊断。真菌培养犬小孢子菌呈阳性，根据这一结果，要求病理学家重新检查切片并对其他组织再次切片，以证明或排除皮肤癣菌病的存在。检查了多个PAS染色切片，未见真菌元素。病例3最终诊断为皮肤癣菌病和丘疹性嗜酸性细胞/肥大细胞性皮炎。 Figure 6 Moderate epidermal hyperplasia and hyperkeratosis with focal parakeratosis and interstitial moderate eosinophilic and mastocytic dermatitis (case 3). H&E, bar = 50 μm 图6表皮层中度增生和角化过度伴局灶性角化不全，中度嗜酸性细胞和肥大细胞浸润性皮炎(病例3)，HE染色，标尺=50μm
The cat was treated for dermatophytosis with itraconazole at 5 mg/kg orally q24h and enilconazole (Imaverol; Janssen Cilag) rinses every fourth day. For papular eosinophilic/ mastocytic dermatitis cetirizine (Zirtec; UCB Pharma) 1 mg/kg orally q24h and fatty acid supplementation (Ribes Pet 80; NBF Lanes) orally q24h were administered. Three weeks later,the papular eruption on the ventral chest had disappeared and treatment for papular eosinophilic/mastocytic dermatitis was discontinued by the owner. The lesions recurred within 1 week and therapy with cetirizineand fatty acids was resumed. Treatment for dermatophytosis was continued until two consecutive negative fungal cultures, performed 4 weeks apart, had been obtained (total duration 10 weeks). 患猫使用伊曲康唑5 mg/kg口服每24小时一次和恩康唑每四天一次浸泡治疗。对丘疹性嗜酸性细胞/肥大细胞性皮炎使用西替利嗪1 mg/kg口服每24小时一次，补充脂肪酸口服每24小时一次。治疗三周后，胸部腹侧丘疹消失，主人停止了对丘疹性嗜酸性细胞/肥大细胞性皮炎的治疗。病变在1周内复发，恢复了西替利嗪和脂肪酸治疗。持续治疗皮肤癣菌病，直到连续两次真菌培养阴性，每4周检查一次，总疗程持续10周。
After the second negative fungal culture,the lesions consistent with papular eosinophilic/ mastocytic dermatitis were in remission and therapy for this disease could be discontinued without further relapses. At the time of writing, 2.5 years later, no recurrence of papular eosinophilic/mastocytic dermatitis had been observed. 在第二次真菌培养阴性后，符合丘疹性嗜酸性细胞/肥大细胞性皮炎的病变得到缓解，对这种疾病的治疗可以停止且没有再复发。在撰写本文时，2.5年后，丘疹性嗜酸性细胞/肥大细胞性皮炎没有复发。
Discussion 讨论 The three cases described here presented with clinical and histopathological features suggestive of papular eosinophilic/mastocytic dermatitis (urticaria pigmentosa-like dermatitis), but were eventually found to be affected by dermatophytosis. 本文所描述的三个病例的临床和组织病理学特征提示丘疹性嗜酸性细胞/肥大细胞性皮炎(色素样荨麻疹性皮炎)，但最终被发现为皮肤癣菌病。
The characteristic cutaneous eruption of papular eosinophilic/mastocytic dermatitis, with hyperpigmented papules and macules, sometimes with a linear distribution and mainly located on the trunk,is very similar in Devon Rex and Sphynx cats and has a juvenile on set in both breeds. Clinical findings in the three cats reported closely resembled the previously described cases of papular eosinophilic/ mastocytic dermatitis, with lesions developing at 7 months to 1 year of age. Dermatophytosis is also very common in young cats,with lesions typically characterised by multifocal alopecia and scaling, and this characteristic presentation along with hyperpigmentation was observed only in case 3. Atypical hyperpigmented circular areas on the trunk have been described also in a young Devon Rex cat with dermatophytosis. Pruritus was reported in all Sphynx cats with urticaria pigmentosa but seemed to be variably present in the Devon Rex cats, as it was for the cats described in this report. The severity of pruritus also varies in cats with dermatophytosis. 皮肤典型特征是突发丘疹性嗜酸性细胞/肥大细胞性皮炎，伴有色素沉着的丘疹和斑块，有时呈线性分布，主要分布在躯干上，这在德文卷毛猫和斯芬克斯猫中表现非常相似，在两个品种中都是幼年发病。这三只猫的临床表现与之前描述的丘疹性嗜酸性细胞/肥大细胞性皮炎非常相似，病变在7个月到1岁时出现。皮肤癣菌病在幼猫中也很常见，其典型特征是多灶性脱毛和皮屑，这种表现伴随色素沉着的表现仅在病例3中观察到。在躯干上的不典型的色素沉着的圆形区域，也在一个年轻的德文卷毛猫皮肤癣菌病中有描述。瘙痒症在所有的患色素性荨麻疹的斯芬克斯猫中有报道，但似乎在本文报道的德文卷毛猫上不存在。瘙痒的严重程度在有皮肤癣菌病患猫上也有所不同。
Fungal culture was positive for two of the three cats (cases 2 and 3) and was not performed in case 1, because the clinical presentation was not particularly suggestive of dermatophytosis. In case 1, the diagnosis was obtained by histopathological examination. A few fungal spores in a single follicular infundibulum could be observed on histopathology in cases 1 and 2,underlining the low sensitivity of histopathology as a diagnostic test for dermatophytosis. In case 3, despite a careful search with the aid of PAS stain, the presence of dermatophytes was not confirmed, while the fungal culture performed by toothbrush technique on the whole body was positive. As biopsies in this cat were also taken from both the ventral chest and the dorsum, it is not possible to ascertain whether dermatophytosis could have been causing a clinical and histopathological reaction compatible with papular eosinophilic/mastocytic dermatitis or whether dermatophytosis could have been just a concurrent infection in a cat with papular eosinophilic/mastocytic dermatitis. 三只猫中有两只(病例2和3)的真菌培养呈阳性，而病例1没有进行真菌培养，因为临床表现并不特别提示有皮肤癣菌病。病例1通过组织病理学检查确诊。病例1和病例2的组织病理学观察到一个毛囊漏斗部中有少量真菌孢子，这说明组织病理学作为皮肤癣菌病诊断试验的敏感性较低。病例3经PAS染色仔细查找，未证实有皮肤癣菌存在，而全身牙刷技术的真菌培养为阳性。在这只猫上的胸部腹侧和背部也进行了皮肤活检，尚不能确定皮肤癣菌病是否是导致丘疹性嗜酸性细胞/ 肥大细胞性皮炎这种临床和组织病理学表现的病因，或皮肤癣菌病只是一只丘疹性嗜酸性细胞/ 肥大细胞性皮炎的患猫的一种并发感染。
The other histopathological features were suggestive of papular eosinophilic/ mastocytic dermatitis in all cases. Histopathologically, the conditions described in Devon Rex and Sphynx cats are both characterised by a moderate to severe, perivascular to diffuse infiltrate of well-differentiated mast cells, with variable numbers of eosinophils, which seem to be more numerous in Devon Rex cats with this disease;fungal cultures were negative in those cases. In feline dermatophytosis, eosinophils may be present within a mixed inflammatory infiltrate around hair follicles, within follicular pustules and in furuncles surrounding free hair shafts, although they are usually observed in small numbers. 其他组织病理学特征提示所有病例均为丘疹性嗜酸性细胞/肥大细胞性皮炎。在德文卷毛猫和斯芬克斯猫病例中组织病理学，都有中度到重度的血管周弥散浸润分化良好的肥大细胞，以及数量多变的嗜酸性细胞的特点,似乎表现这种疾病多发生在德文卷毛猫，真菌培养结果为阴性的病例中。在猫皮肤癣菌病中，嗜酸性细胞可能存在于毛囊周围、毛囊脓疱内和游离毛干周围的疖病内的混合炎性浸润中，但它们通常很少被观察到。
All cases were treated with antifungals(systemic itraconazole and, in case 3, topical enilconazole), and showed a complete response. Enilconazole is not licensed for cats, as fatal idiosyncratic reactions have been reported; however, studies have since shown that it can be used safely in cats. In case 2, dermatophytosis recurred following participation in a cat show, but this was considered to be a reinfection and notarelapse.In case 3,cetirizine and essential fatty acids were also prescribed, as recommended by Noli et al, because the cat was diagnosed as having papular eosinophilic/mastocytic dermatitis and concurrent dermatophytosis. Cetirizine and essential fatty acids could be permanently discontinued only after complete resolution of dermatophytosis, confirmed by negative fungal culture. No relapses of papular eosinophilic/mastocytic dermatitis were observed over the following 2.5 years. 所有病例均给予抗真菌药物治疗(全面使用伊曲康唑，第3例外用恩康唑)，并完全缓解。恩康唑没有被批准用于猫，因为有致命的特异反应的报道;然而，研究表明，它可以安全地用于猫。病例2，在猫参加猫展后皮肤癣菌病复发，但认为这是再次被传染而不是复发。病例3中，按照Noli等人的建议，还使用了西替利嗪和必需脂肪酸，因为猫被诊断为丘疹性嗜酸性细胞/肥大细胞性皮炎和并发皮肤癣菌病。经真菌培养阴性证实皮肤癣菌病痊愈后，西替利嗪和必需脂肪酸才能完全停药。在接下来的2.5年中，未观察到丘疹性嗜酸性细胞/肥大细胞性皮炎复发。
Conclusions 结论 Cases 1 and 2 represented atypical dermatophytosis mimicking papular eosinophilic/ mastocytic dermatitis (urticaria pigmentosalike dermatitis), as confirmed by positive fungal culture in case 2, by observing fungal spores in follicular infundibula in both cases and by response to antifungal treatment in both cats. Case 3 was different, as histopathological examination did not allow us to observe fungal spores despite a positive fungal culture and the cat seemed to respond to both antifungal and antihistamine and fatty acids treatments.This suggests either that dermatophytosis in Devon Rex cats could present with clinical and histopathological features identical to papular eosinophilic/mastocytic dermatitis or that this latter condition represents a breed-specific reaction pattern triggered by different diseases such as allergies or dermatophytosis, as proposed by Noli et al. 病例1和2表现与丘疹性嗜酸性细胞/肥大细胞性皮炎(色素样荨麻疹性皮炎)相似的非典型性皮肤癣菌病，病例2经真菌培养阳性确诊，观察到两例猫的毛囊漏斗部中的真菌孢子，以及两例猫对抗真菌治疗的效果，证实了这一点。病例3有所不同，尽管真菌培养呈阳性，但组织病理学检查未观察真菌孢子，而且猫似乎对抗真菌、抗组胺和脂肪酸治疗都有效果。Noli等人提出，这表明德文卷毛猫的皮肤癣菌病可能有丘疹性嗜酸性细胞/ 肥大细胞性皮炎的临床和组织病理学特征，要么这种特征表现是由其他疾病，像是过敏症或皮肤癣菌病诱发的一种品种特异性的反应模式。
Therefore, at least in the Devon Rex breed, dermatophytosis should always be carefully ruled out in cats presenting with clinical and histopathological features suggestive of papular eosinophilic/mastocytic dermatitis. Wood’s lamp examination, microscopic examination of hair shafts and fungal culture, as well as a careful search for dermatophytes on biopsies, which are suggestive of this disease, are strongly recommended, as the clinical presentation is atypical for feline dermatophytosis and fungal spores may be extremely difficult to find. The differential diagnosis is crucial and has a strong clinical relevance because most cases of papular eosinophilic/ mastocytic dermatitis may be treated with glucocorticoids, which are contraindicated in cases of dermatophytosis. 因此，至少在德文卷毛猫品种中，临床和组织病理学特征提示丘疹性嗜酸性细胞/肥大细胞性皮炎的猫应始终仔细地排除皮肤癣菌病。强烈建议这种疾病进行伍德氏灯检查、拔毛显微镜检查和真菌培养,以及皮肤活检仔细寻找皮肤癣菌元素，因为是非典型性猫皮肤癣菌病的临床表现，且可能很难找到真菌孢子。鉴别诊断很重要，且具有很强的临床相关性，因为大多数丘疹性嗜酸性细胞/肥大细胞性皮炎可能使用糖皮质激素治疗，而糖皮质激素使用对于皮肤癣菌病是禁忌。
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发表于 2021-6-24 18:55:03
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