Generalized Calcinosis Cutis Associated with Prolonged Glucocorticoid Therapy for Hemolytic Anemia Secondary to Babesiosis in a Scottish Terrier
A.G. Pöppl1; M.L. Buzin2; C.C. Do Nascimento3; J. Fisch3; L.M. Pereira3; C.S. Lasta1
Calcinosis cutis is characterized by dystrophic calcium deposition in the dermis and subcutis due to phase transformation of calcium and phosphate ions from solution in to crystalline aggregate with deposition in matrices of dermal collagen and elastin. A four-year-old Scottish Terrier was received with hemolytic anemia secondary to Babesia canis infection. The animal was extremely icteric and with free abdominal fluid. Above supportive treatment, imidocarb (5 mg/kg IM) was given, as well as doxycycline (10 mg/kg PO) once daily was started. To treat hemolytic anemia, 15 mg/kg of methylprednisolone sodium succinate was infused IV in the first day, following infusion of 7.5 mg/kg and 3.75 mg/kg on second and third days respectively. After this, prednisone (1 mg/kg PO) was started once daily, and a good response was seen by the fifth day. However, as the prednisone therapy starts reduction (half dose each week), the dog evidenced severe signals of hypoadrenocorticism with intense depression/lethargy, anorexia and weakness. Returning to anterior prednisone dose derived to normalization of this abnormalities. After 32 days from the first consult, the owner bring the depressed and anoretic dog back to the clinic after a new prednisone dose reduction, however there was generalized, non itching red firm irregular plaques with hyperproliferative margins. This plaques were distributed along temporal area of the head, ears, dorsal midline, neck, ventral abdomen, internal thigh surface and inguinal areas. An ACTH stimulation test showed basal cortisol 0.78 μg/dL and cortisol post-stimulation 2.79 μg/dL (reference range basal: 0.5-6 μg/dL / post-ACTH: 6-17 μg/dL). Calcium and phosphorus levels were within reference range. A more slowly prednisone reduction was recommended and a DMSO gel was prescribed for topical use above the plaques, with complete resolution of lesions in few weeks. Notwithstanding calcinosis cutis is a rare condition associated with Cushing's syndrome, there are few cases of generalized calcinosis cutis in adult dogs after severe systemic diseases; blastomycosis and leptospirosis have been implicated. To the authors' knowledge, there was no report of generalized calcinosis cutis in a dog associated to immunosuppressive glucocorticoid therapy or babesiosis.