Recognizing and treating ProMeris-triggered pemphigus foliaceus in dogs - Veterinary Medicine
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Recognizing and treating ProMeris-triggered pemphigus foliaceus in dogs
These two case reports outline a basic diagnostic and treatment plan—and, thus, should help you manage this unusual disease.


Dermatologic examination

At presentation to the dermatology service, the patient was in good general health aside from its left front leg lameness and extensive skin lesions. The dermatologic examination revealed a 30-x-30-cm area of crusting in the interscapular region that extended down the shoulder blades (Figures 1A & 1B). Crusts were also evident on the concave aspects of both pinnae (Figure 1C), and hyperkeratosis was noted on the footpads on the left front foot, possibly suggesting previous epithelial damage.

Figure 1A-1C. The patient in Case #1 at presentation: 1A) The lesions at the ProMeris application site (the area is partially shaved). 1B) A close-up of this region reveals severe crusting, mild erythema, and shallow erosions underneath these crusts. 1C) In addition to lesions at the preventive application site, crusts, mild erythema, and scaling were discovered on the concave aspects of the pinnae.
Cytologic examination of purulent exudate obtained from a crusted lesion on the shoulder revealed neutrophils and acantholytic keratinocytes suggestive of pemphigus foliaceus. The original biopsy samples were requested for review. Serum was collected for detection of circulating antikeratinocyte autoantibody by indirect immunofluorescence in the NCSU laboratory.

Diagnosis and treatment

Pending the histologic examination and immunologic testing results, and based on the strong suspicion of ProMeris-triggered pemphigus foliaceus, the glucocorticoid was changed to prednisolone, and the dose was increased to 1.5 mg/kg twice daily, while tramadol was to be given as needed to relieve pain.

The results of the histologic examination confirmed the presence of superficial epidermal neutrophilic pustular dermatitis with keratinocyte acantholysis. Bacteria or dermatophytes in the stratum corneum were not seen by using special stains. Direct immunofluorescence performed on paraffin-embedded skin sections revealed intercellular deposits of IgG and IgM in lesional and perilesional epidermis. Circulating antikeratinocyte autoantibodies were not detected at a 1:20 serum dilution.

All together, the dog's history, clinical signs, and results of cytologic and histologic examinations and direct immunofluorescence testing were highly suggestive of a diagnosis of ProMeris-triggered pemphigus foliaceus.


The dog returned for a reevaluation the next week. The skin lesions had markedly improved—only minor crusting was present in the interscapular region and pinnae. The dog no longer exhibited signs of lameness, and the tramadol was discontinued. The prednisolone dose was tapered over the next 11 days, and the disease has remained in remission without any relapse for more than two years. The dog subsequently began to receive Frontline Plus (Merial) as a topical flea and tick preventive. This product was well-tolerated, and no recurrence of the skin lesions was reported by the owner.


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