Cutaneous xanthomas with concurrent demodicosis and dermatophytosis in a cat

Abstract

Multiple cutaneous xanthomas, associated with fasting hyperlipidaemia, are described in a 9-month-old domestic long-haired cat. A severely pruritic, papular, and crusting dermatitis affecting the head and neck, initially diagnosed as lesions of the eosinophilic granuloma complex, progressively developed on the head and pinnae. Pruritus was controlled with administration of prednisolone and chlorambucil. Repeat histological examination confirmed the diagnosis of cutaneous xanthoma and concurrent mild demodicosis. Marked fasting hypercholesterolaemia, hypertriglyceridaemia and transient hyperglycaemia were subsequently confirmed. Treatment for hyperlipidaemia and xanthomas with a low-fat diet (Hill's Feline r/d) and the previously unreported treatment for feline demodicosis of daily oral milbemycin were commenced. Multiple pink, alopecic plaques and papules gradually regressed, however pruritus recurred if immunosuppressive treatment was reduced, and well-demarcated areas of alopecia developed on the head, limbs and trunk, despite negative skin scrapings for demodex mites. Fungal culture of hair samples yielded Microsporum canis. All cutaneous lesions resolved with the addition of griseofulvin to the treatment regimen. Concurrent corneal ulceration and keratoconjunctivitis sicca ultimately resolved with treatment, including topical cyclosporin. Diabetes mellitus developed 6 months after resolution of skin lesions. No cutaneous or ocular abnormalities were present 6 months later with continued low-fat diet and insulin administration, although transient recurrence of papules and pruritus occurred after inadvertent access to a fatty meal. An underlying primary hyperlipidaemia was suspected, causing pruritic xanthomas. This may represent the first report of concurrent cutaneous xanthomas, demodicosis and dermatophytosis in a cat.

Localized demodicosis due to Demodex cati on the muzzle of two cats treated with inhalant glucocorticoids

“…Although avermectins have been used to treat feline demodicosis in few reported cases with variable success, 5,32-34 reports of using milbemycin for treatment of demodicosis in cats are limited. 35 In both cats, the alopecia, crusting, scaling and pruritus resolved fully within 2 months after starting the daily administration of milbemycin. However, given that additional treatment changes involving the use of the topical fluticasone were made, it could be hypothesized that the reduced exposure of the skin to the topical glucocorticoid restored the local skin immunity, thus resulting in the disease remission.…”

“…Milbemycin oxime is a macrocyclic lactone with a similar spectrum of activity to ivermectin. Although avermectins have been used to treat feline demodicosis in few reported cases with variable success, reports of using milbemycin for treatment of demodicosis in cats are limited . In both cats, the alopecia, crusting, scaling and pruritus resolved fully within 2 months after starting the daily administration of milbemycin.…”

Diagnosis and treatment of dermatophytosis in dogs and cats.

“…However, in another study, no association between FIV infection and fungal carriage was noted . There is one study reporting a cat with cutaneous xanthomas and concurrent demodicosis and dermatophytosis . The development of concurrent dermatophytosis in cats receiving immunosuppressive drugs for the treatment of pemphigus foliaceus was not reported in either of two large studies .…”

The use of oral fluralaner for the treatment of feline generalised demodicosis: a case report

“…Several medications have been reported for the treatment of feline demodicosis with variable outcome, depending on the causative agent and on the frequency and dosage of drug administration (Foley 1995, Vogelnest 2001, Johnstone 2002, Mueller 2004, Löwenstein et al . 2005, Morris & Beale 2006, Saari et al .…”

“…gatoi (Johnstone 2002, Mueller 2004 Daily oral dose of 1 to 1·5 mg/kg milbemycin oxime was shown to be effective against D . cati when administered for 8 to 27 weeks but neurological signs were observed (Vogelnest 2001, Bizikova 2014. Weekly application of a topical 10% imidacloprid/1% moxidectin combination for eight weeks was reported to be effective in treating D .…”