Camila Ferreira da Silva, Christoforos Posporis, Caroline Fina, Lisa Stammeleer

IVC Evidensia – Pride Veterinary Referrals, Derby, United Kingdom

Objectives

We aim to describe a complex case of steroid-responsive sterile pyogranulomatous disease in a Springer Spaniel initially presented with a 3-week-history of pyrexia and multiple circular, alopecic and ulcerated cutaneous lesions affecting the face, thorax, abdomen and limbs.

Methods

Based on skin biopsies, negative skin cultures, negative Ziehl-Neelsen and PAS stains on cytology and elevated C-reactive protein, multifocal pyogranulomatous dermatitis was diagnosed.

Results

Prednisolone (1mg/kg/day) and paracetamol were started, and the lesions resolved with normalisation of CRP. However, 17 weeks after starting corticosteroids, the patient re-presented with ataxia and spinal pain. Neurological examination revealed a multifocal spinal cord neurolocalisation. CRP was elevated, blood and urine cultures, and Brucella FASTest® were negative. Echocardiography was unremarkable. CT revealed multifocal changes in the cervical, thoracic and lumbar spine characterized by mottled vertebral bodies with spiculated periosteal reaction and extensive lumbar epidural steatitis. A right-sided L2-L3 hemilaminectomy was performed and specimens (vertebral lamina, articular processes, paravertebral soft tissues, epidural fat) were collected. Histopathology identified chronic pyogranulomatous vertebral osteomyelitis and histiocytic to pyogranulomatous epidural steatitis with necrosis. Extended cultures and Mycobacterium PCR on the specimens were negative. Immune-mediated sterile pyogranulomatous dermatitis and vertebral osteomyelitis with epidural steatitis were diagnosed, and prednisolone dose was increased (2mg/kg/day). Five weeks later, mild neurological deficits remained, and CRP was normal. A repeat CT is planned.

Statement: Impact/ Clinical Significance

This case report illustrates an atypical presentation of steroid-responsive pyogranulomatous disease that should be considered in different patient presentations. Notably, although the initial clinical signs resolved, the immune-mediated disease progressed. The initial prednisolone dosage was inadequate.