Contrasting treatment responses by Burkholderia cepacia complex-related deep pyoderma: A series of two cases.
Contrasting treatment responses by Burkholderia cepacia complex-related deep pyoderma: A series of two cases.
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DOI：
10.5455/ovj.2022.v12.i3.1
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发表时间：
2022-05
影响因子：
1.2
通讯作者：
Motegi, Tomoki
中科院分区：
文献类型：
--
作者：
Shinomiya, Yuki;Takagaki, Shingo;Kawakami, Yoshiki;Motegi, Tomoki
洋葱伯克霍尔德氏菌复合体（Bcc）是人类和动物中的机会致病菌。这些细菌在狗身上引起的深部脓毒症以前曾有报道。该病例系列旨在描述两只犬（一只雄性和一只雌性）中BCC相关深部脓毒症的对比治疗反应。这两名患者都有免疫介导的多关节炎（IMPA）病史，口服环孢素和泼尼松龙治疗。他们的皮肤病变为多灶性、不规则、肿胀至出血性、脱发性丘疹、斑块和结节，伴有广泛结痂、引流道和溃疡。细胞学结果显示，由非变性和变性中性粒细胞和巨噬细胞组成的显著炎症反应，伴有中度至大量的细胞内和细胞外Bcc。例2确诊后停用环孢素和泼尼松龙。然而，由于IMPA复发和医源性肾上腺皮质功能减退症的发作，在病例1中停止该方案具有挑战性。病例1由于多次复发，即使使用7种方案也未达到缓解约66周，而病例2使用一种药物仅用3周即可达到缓解。对于免疫抑制患者的深部脓毒症伴广泛病变，应考虑基底细胞癌感染。因此，应立即减少免疫抑制剂在这类患者，然后，强化抗菌治疗可能会达到缓解。
The Burkholderia cepacia complex (Bcc) is an opportunistic pathogen in humans and animals. Deep pyoderma caused by these bacteria in dogs has been previously reported. This case series aims to describe contrasting treatment responses in Bcc-related deep pyoderma in two dogs, a male and a female. Both patients had a history of immune-mediated polyarthritis (IMPA) managed with oral ciclosporin and prednisolone. Their skin lesions were multifocal, irregular, erythematous to hemorrhagic, alopecic papules, plaques, and nodules, with extensive crusting, draining tracts, and ulceration. Cytological findings revealed a marked inflammatory response consisting of non-degenerative and degenerative neutrophils and macrophages, with moderate to abundant intracellular and extracellular Bcc. Ciclosporin and prednisolone were stopped in case 2 after diagnosis. However, it was challenging to stop the regimen in case 1 because of the recurrence of IMPA and the onset of iatrogenic hypoadrenocorticism. Case 1 did not achieve remission for approximately 66 weeks even with seven protocols because of multiple relapses, whereas it took only 3 weeks to achieve remission in case 2 while using one drug. For deep pyoderma with extensive lesions in immunosuppressed patients, one should consider infection with Bcc. Therefore, immunosuppressants should promptly be reduced in such patients, and then, intensive antimicrobial therapy may achieve remission.