scott@vtx-cpd.com

Hey.

This article has just been released in JVIM, thought it was good timing for your case!

Clinical features and amino acid profiles of dogs with hepatocutaneous syndrome or hepatocutaneous-associated hepatopathy

Abstract
Background: Superficial necrolytic dermatitis (SND), hepatocutaneous-associated hepatopathy (HCH), aminoaciduria, and hypoaminoacidemia define hepatocutaneous syndrome (HCS) in dogs. Dogs without SND but that possess all other syndrome components are not well described.

Hypothesis/objectives: To define an inclusive syndrome, aminoaciduric canine hypoaminoacidemic hepatopathy syndrome (ACHES) for dogs with HCH or HCS. Compare clinical features, salient clinicopathologic variables, and plasma and urine amino acid (AA) profiles among ACHES cases by skin lesion status.

Animals: Dogs of various breeds and ages diagnosed with ACHES (n = 41). A control (CON) cohort (n = 12) provided AA profile data.

Methods: Retrospective case series. Available medical records of previously identified cases were reviewed for salient clinical features and clinical pathology data. Plasma and urine AA profiles were performed. Cutaneous lesion status was classified as none, mild, or fulminant.

Results: Thirty cases (73%) developed SND at some time. Dogs with fulminant skin lesions at diagnosis (n = 22/41, 54%) had significantly lower hematocrit (P = .05) and mean corpuscular volume (P = .01) than dogs without SND. Principal component analysis of plasma AA profiles identified distinct clustering of CON from ACHES dogs, but not by skin lesion status. Plasma 1-methylhistidine (<7 nmol/mL) and cystathionine (<7.5 nmol/mL) were robust ACHES biomarkers. Urine lysine (>344 nmol/mg creatinine) and methionine (>68 nmol/mg creatinine) also were useful ACHES biomarkers.

Conclusions and clinical importance: Specific AA biomarkers provide additional diagnostic utility in ACHES. Data suggests that HCH is an early stage, and SND a later stage manifestation of ACHES.

Scott x

Replying to Hannah Sivills 04/10/2021 - 20:16

Lovely to hear from everyone.

Thank you for the feedback regarding the first session. Would be great to have your feedback. Acid base can be a tough sell!

Scott 🙂

Hello everyone!

Just wanted to say hello too. My name is Scott and I have the privilege of taking you through the first lesson.

Please let me know if you have any questions at any time. If you are not comfortable popping them on the discussion forum then drop me an email:

scott@vtx-cpd.com

I look forward to hearing a bit about you all.

Scott 🙂

This is a really interesting case!!!!

Do you have any blood work that you could share?

Superficial necrolytic dermatitis is assumed to be secondary to an underlying metabolic disorder. The resulting hepatic and cutaneous changes are characteristic and much more severe and serious than those associated with the common secondary vacuolar hepatopathies reported with many endocrinopathies. In humans, most cases have a glucagon-secreting tumor and concurrent diabetes mellitus. A few dogs have been reported with glucagonomas, which are usually metastatic, and one case has been reported in a dog with an insulinoma. In most canine cases, there is no identifiable mass, serum glucagon concentration is normal, and the cause remains obscure. Superficial necrolytic dermatitis also has been reported in 11 dogs being treated with phenobarbital, although the contribution of the antiepileptic to the disease was unclear in this retrospective study and the response to stopping treatment was not known.

The adrenal changes is interesting. I suppose you would have to go down the road of demonstrating it is not functional. You could consider serial BP measurements, catecholamine assessment, ACTH stim or LDDST.

What is that plan with the dog?

Thanks so much for sharing!

Scott 🙂