This report describes a case of sterile pyogranuloma syndrome managed with immunomodulatory therapy and seed skin grafting. Seed skin grafting can be considered as part of a multimodal treatment approach for cutaneous defects caused by ulcerative immune-mediated diseases where secondary intention healing is delayed or contraindicated, and other forms of wound reconstruction may be prohibitive.

BackgroundHymenoptera envenomation with honey bee (Apis mellifera) and paper wasp (Polistes spp.) may cause life‐threatening anaphylaxis in dogs. In human patients, clinical history, intradermal testing (IDT) and measurement of allergen‐specific serological immunoglobulin (Ig)E (sIgE) are used to support a diagnosis of Hymenoptera venom hypersensitivity. The utility of venom allergen‐specific sIgE has not yet been evaluated for this purpose in dogs.ObjectivesThe objective of the study was to investigate the sensitivity (sn), specificity (sp) and positive predictive value (PPV) of honey bee and paper wasp serological titres using a commercially available sIgE assay [VARL (Veterinary Allergen Reference Laboratory) Liquid Gold] against clinical history for a diagnosis of Hymenoptera hypersensitivity in dogs.Materials and MethodsHoneybee and paper wasp IgE serum titres were measured in 15 client‐owned dogs with a diagnosis of Hymenoptera venom hypersensitivity based on a history of anaphylaxis, owner observation of Hymenoptera, and positive IDT to bee and/or wasp; and in 10 client‐owned dogs with no known history of anaphylaxis or Hymenoptera exposure and a negative IDT to bee and wasp.ResultsAnalysis of receiver operating characteristic (ROC) curves demonstrate that a VARL score cut‐off of one of six for honeybee yields Sn, Sp and PPV of 40%, 60% and 60%, respectively, and two of six for wasp yields Sn, Sp and PPV of 25%, 78% and 60%, respectively.Conclusions and Clinical RelevanceOwing to the poor sensitivity and PPV of sIgE assays for both bee and wasp hypersensitivity in dogs with known envenomation and anaphylaxis, the use of sIgE cannot be recommended as a tool for venom identification.