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Diagnosis and treatment of truncal cutaneous pythiosis in a dog

Kelley M. ThiemanDepartment of Small Animal Clinical Sciences, Veterinary Medical Center, College of Veterinary Medicine, University of Florida, Gainesville, FL32611.

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 DVM, MS
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Kristin A. KirkbyDepartment of Small Animal Clinical Sciences, Veterinary Medical Center, College of Veterinary Medicine, University of Florida, Gainesville, FL32611.

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Alison Flynn-LurieDepartment of Small Animal Clinical Sciences, Veterinary Medical Center, College of Veterinary Medicine, University of Florida, Gainesville, FL32611.

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Amy M. GrootersDepartment of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA 70803.

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Nicholas J. BaconDepartment of Small Animal Clinical Sciences, Veterinary Medical Center, College of Veterinary Medicine, University of Florida, Gainesville, FL32611.

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Abstract

Case Description—A 4-year-old spayed female Boxer was evaluated for a cutaneous mass located on the dorsum. The mass had been present for 6 weeks and was increasing in size.

Clinical Findings—A mass of approximately 10 cm in diameter was detected on the dorsum cranial to the right ilial wing. Histologic examination of a tissue sample from the mass led to the diagnosis of cutaneous pythiosis. Computed tomography of the abdomen and the mass were performed and revealed a contrast-enhancing soft tissue mass of the dorsum and enlarged intra-abdominal lymph nodes.

Treatment and Outcome—The dog underwent surgical excision of the cutaneous mass, including 5-cm skin margins and deep margins of 2 fascial planes. The mass was completely excised on the basis of results of histologic examination of surgical margins. The dog received itraconazole and terbinafine by mouth for 3 months following surgery. Recheck examination at 20 months postoperatively showed no signs of recurrence of pythiosis at the surgical site.

Clinical Relevance—Aggressive surgical excision in combination with medical treatment resulted in a favorable long-term (> 1 year) outcome in this dog. Thorough workup including diagnostic imaging and lymph node evaluation is recommended. If surgery is to be performed, skin margins of 5 cm and deep margins of 2 fascial planes are recommended.

Abstract

Case Description—A 4-year-old spayed female Boxer was evaluated for a cutaneous mass located on the dorsum. The mass had been present for 6 weeks and was increasing in size.

Clinical Findings—A mass of approximately 10 cm in diameter was detected on the dorsum cranial to the right ilial wing. Histologic examination of a tissue sample from the mass led to the diagnosis of cutaneous pythiosis. Computed tomography of the abdomen and the mass were performed and revealed a contrast-enhancing soft tissue mass of the dorsum and enlarged intra-abdominal lymph nodes.

Treatment and Outcome—The dog underwent surgical excision of the cutaneous mass, including 5-cm skin margins and deep margins of 2 fascial planes. The mass was completely excised on the basis of results of histologic examination of surgical margins. The dog received itraconazole and terbinafine by mouth for 3 months following surgery. Recheck examination at 20 months postoperatively showed no signs of recurrence of pythiosis at the surgical site.

Clinical Relevance—Aggressive surgical excision in combination with medical treatment resulted in a favorable long-term (> 1 year) outcome in this dog. Thorough workup including diagnostic imaging and lymph node evaluation is recommended. If surgery is to be performed, skin margins of 5 cm and deep margins of 2 fascial planes are recommended.

Contributor Notes

Dr. Kirkby's present address is Seattle Veterinary Specialists, 11814 115th Ave NE, Kirkland, WA 98034.

Dr. Flynn-Lurie's present address is Miami Veterinary Specialists, 8601 Sunset Dr, Miami, FL 33173.

Dr. Thieman's present address is Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Texas A&M University, College Station, TX 77843.

The authors thank Dr. Ian Hawkins for histologic interpretation.

Address correspondence to Dr. Thieman (kthieman@cvm.tamu.edu).