Acute necrotising stomatitis

RE: Acute necrotising stomatitis

Rob Davis — Mon, 20 Sep 2021 14:54:37 GMT

Update:

Histology was non-specific: ulcerative stomatitis with chronic-active inflammation. No sign of auto-immune disease or vasculitis.

Within a few days of the above photos, she developed another similar-looking circular necrotic lesion in the skin adjacent to her right left fore dew claw, but the oral lesions were improving. All lesions have continued to improved since then as in photos below. No treatment other than scaling and polishing and oral clindamycin has been given.

I guess it will remain a mystery, but I will update further if any new lesions develop.

Thanks, Alix and Rachel for your thoughts.

RE: Acute necrotising stomatitis

Rachel Perry — Wed, 01 Sep 2021 11:35:39 GMT

Hi Rob,

I'd agree with Alix's thoughts. What has happened to the periorbital region, and ventrum? Pentoxifylline might not be a bad idea to start, and maybe add in metronidazole to the amox-clav. I had one like this that required repeated surgical debridement of the lesions to get any sign of resolution. I also had a weird case like this that I am convinced was a paraneoplastic syndrome, so do keep an eye on the whole patient.

Keep us posted.

RE: Acute necrotising stomatitis

Rob Davis — Sat, 28 Aug 2021 11:16:35 GMT

Hi Alix,

Thanks for the rapid response! This largely echoes my thoughts, though I was unaware of the Krug paper so I will go an have a read of that.

She has not travelled outside the UK, was last vaccinated in June and was not on any medication prior to the onset. I have taken biopsies, performed a thorough scale and polish and started oral antibiotics. I will update when I receive the histopath results.

RE: Acute necrotising stomatitis

Alix Freeman — Sat, 28 Aug 2021 10:11:17 GMT

Hi Rob.

I have seen lesions like this in a cocker spaniel with CCUS but given the generalised signs you describe, I would strongly suspect that this dog has some sort of vasculitis, either triggered by whatever caused the facial swelling or that concurrently caused the facial swelling. Possible causes could be drugs (including vaccines, esp rabies vaccine), neoplasia, infection. Vasculitis can also be idiopathic. Has the dog got a history of travel? I would also perform haem and biochem to check for signs of other organ damage associated with a possible vasculitis, and to look for a trigger.

I would advise biopsies of the oral cavity lesions and any lesions that you can see elsewhere (skin). There is a syndrome known as Wegeners granulomatosis, described in a dog by Krug in JVD 2006 which i'd also list as a possible differential. I think I would continue to manage as you are while awaiting the biopsy results but I think there is justification for systemic antibiotics in this case (i'd probably chose a broad spec bacteriocidal antibiotic such as co-amoxyclav). I'd also suspect that this patient was very painful so would consider additional pain relief such as paracetamol. Ultimately this patient may need immunosuppressive treatment but i'd reluctant to start this before I had biopsy results.

Alix