An 8-year-old male collie dog with a presumptive diagnosis of immune-mediated disease was referred for consultation because of inadequate response to glucocorticoid therapy and weakness. Additional diagnostics, including skin biopsy, antinuclear antibody testing, and electromyography, were conducted. A definitive diagnosis of vesicular cutaneous lupus erythematosus was made, and the dog was treated with a combination of antibiotics, azathioprine, and prednisolone. New lesions continued to develop, and therapy was changed to oral prednisone, ketoconazole, and oral cyclosporine. The dog markedly improved within 12 days; after 2.5 months, the lesions had resolved and the dog was considered normal. The dog was followed for 18 months; after 15 months of remission, ketoconazole therapy was discontinued and cyclosporine therapy (2 mg/kg Q 24 H) was continued.
COMMENTARY: Vesicular cutaneous lupus erythematosus is believed to be a variant of lupus erythematosus and has been described in rough collie dogs and Shetland sheepdogs. Some dogs also have a concurrent myositis, and there may be a relationship to dermatomyositis. Treatment of the condition is difficult, and the disease has been reported to only partially respond to steroids.1 There have been anecdotal reports that cyclosporine is effective as treatment, but this is one of the first well-documented cases with substantial follow-up. In this patient, initial therapy included oral antibiotics for secondary infections. Remission was induced by using a combination of oral prednisone, 0.2 mg/kg Q 12 H; ketoconazole, 4 mg/kg Q 24 H; and oral cyclosporine, 4 mg/kg Q 24 H. Ketoconazole slows the metabolism of cyclosporine, allowing use of lower doses. It is important to note that even though a rapid response was seen, the authors gradually decreased therapy over months; owners need to know that treatment is most likely to be lifelong.
1. Eleven cases of vesicular cutaneous lupus erythematosus in Shetland sheepdogs and rough collies: Clinical management and prognosis. Jackson HA. Vet Dermatol 15:37-41, 2004.
Treatment with oral cyclosporine A of a case of vesicular cutaneous lupus erythematosus in a rough collie. Font A, Bardagi M, Mascort J, Fondevila D. VET DERMATOL 17:440-442, 2006.