Manifestaciones Sistémicas de Enfermedades de la Piel

Systemic signs are rarely observed associated to the most common skin diseases presented in cats. However, in few more atypical dermatological disorders, which represent a disease process that is multi-systemic, skin manifestation may be observed together with some systemic clinical signs. Therefore, recognition of both cutaneous and systemic signs will provide the key to consider those more uncommon diseases in the differential diagnoses list.

Infectious Diseases

Infectious disorders that can present either with dermatological and systemic signs are systemic mycosis, viral, bacterial and protozoal infections.

For details regarding systemic signs of viral infections see the proceedings related to "Viral Skin Diseases in Cats".

Many systemic or deep mycoses (cryptococcosis, blastomycosis, coccidioidomycosis, aspergillosis, histoplasmosis and, in few cats, sporotrichosis) can present with cutaneous lesions along with signs referable to infection in other organ systems. Signs such as anorexia, weight loss, fever, cough, dyspnea, ocular or central nervous signs or lameness may be present in those cases.

Among bacterial infections able to produce systemic signs, mycobacterial infections are the most common. Tuberculosis, an infection caused by obligate mycobacterial parasites (M. tuberculosis complex) is associated with single or multiple nodules and abscesses in a usually sick cat with anorexia, weight loss, fever and localized or generalized lymphadenomegaly. Other mycobacterial infections are rarely associated to systemic signs, although infection by rapidly growing mycobacteria in an immunosuppressed cat, widespread skin lesions can develop, and the cat may be pyrexic, inappetent, and depressed.

Nocardiosis is associated to weakness, anorexia, fever, depression, dyspnea and neurologic signs.

Leishmaniosis is less common in cats than in dogs. Lymph node enlargement, weight loss, ocular involvement (nodular blepharitis, uveitis, panophthalmitis), decreased appetite, chronic gingivostomatitis and lethargy are the most frequent non-cutaneous findings. Dehydration, pale mucous membranes, vomiting, hepatomegaly, fever, jaundice, polyuria/polydipsia, spleen enlargement, nasal discharge, recurrent abortion and dyspnea are also found, although less often.

Paraneoplastic Diseases

Paraneoplastic skin diseases represent a group of skin disorders that if recognized should alert the clinician to underlying internal neoplastic disease.

Feline Paraneoplastic Alopecia

Ventrally pronounced alopecia in which the skin appears very shiny and smooth but is not fragile. Mainly associated to pancreatic adenocarcinoma, and less frequently to bile duct carcinoma. Associated systemic signs are anorexia, weight loss, vomiting, diarrhea and lethargy.

Feline Thymoma-Associated Exfoliative Dermatitis

Some cats may show cough and dyspnoea due to the cranial mediastinal mass. However, in most cases skin changes precede any other systemic sign.

Metastatic Lesions from Pulmonary Adenocarcinoma

Cats may have no respiratory signs so it is important to obtain thoracic images in all cats with digital swelling or lameness.

Immune-Mediated or Autoimmune Diseases

These dermatoses are uncommon in cats. Of all feline dermatoses, only a 1.3% is thought to be related to this group of diseases.

Pemphigus foliaceous is by far the most common autoimmune skin diseases in cats. Single cases of pemphigus erythematosus and pemphigus vulgaris have been described. Affected cats are usually lethargic, febrile and anorectic.

Systemic lupus erythematosus has been described in the cat. However, the paucity of reported cases has precluded the in-depth investigations that have been undertaken on the canine condition. About 50% of described cases showed dermatologic manifestations characterized by generalized seborrheic skin disease, exfoliative erythroderma and crusting and scaling lesions usually symmetric involving the face and ears. Glomerulonephritis and haemolytic anemia were evident in about half of the reported cases. Neurologic signs are more common than in the canine condition, and affect 50% of cases. Fever, lymphadenomegaly and thrombocytopenia are sometime noted.

Among immune-mediated diseases, erythema multiforme/toxic epidermal necrolysis are uncommon skin diseases that may be observed in cats systemically ill. Fever, depression and anorexia may coexist with the sometimes extensive vesiculobullous and ulcerative lesions.

Nutritional or Metabolic Skin Diseases

Acquired Skin Fragility

Often associated with hyperadrenocorticism (adrenal tumours), iatrogenic hyperglucocorticism or excessive levels of progestational compounds. Less common it is associated with hepatic lipidosis and hepatic neoplasia.

Superficial Necrolytic Dermatitis

It can be paraneoplastic if associated with glucagonoma but it is more commonly associated with some yet to be determined alterations in metabolism that causes depletion of amino acids (hepatopathy). The extra-cutaneous signs use to be lethargy, anorexia, weight loss and sometimes poliuria-polidipsia.

References

1.  Miller WH, Griffin CE, Campbell LK. Muller and Kirk's: Small Animal Dermatology. 7th ed. Philadelphia, PA: WB Saunders Co; 2013.

2.  Gross TL, Ihrke PJ, Walder EJ, et al. Skin Diseases of the Dog and Cat, Clinical and Histopathologic Diagnosis. 2nd ed. Oxford, UK: Blackwell Science Ltd; 2005.

3.  Gunn-Moore DA. Feline mycobacterial infections. Vet J. 2014;201(2):230–238.

4.  Lloret A, Hartmann K, Pennisi MG, Ferrer L, Addie D, Belák S, Boucraut-Baralon C, Egberink H, Frymus T, Gruffydd-Jones T, Hosie MJ, Lutz H, Marsilio F, Möstl K, Radford AD, Thiry E, Truyen U, Horzinek MC. Rare systemic mycoses in cats: blastomycosis, histoplasmosis and coccidioidomycosis: ABCD guidelines on prevention and management. J Feline Med Surg. 2013;15(7):624–627.

5.  Lloret A, Hartmann K, Pennisi MG, Ferrer L, Addie D, Belák S, Boucraut-Baralon C, Egberink H, Frymus T, Gruffydd-Jones T, Hosie MJ, Lutz H, Marsilio F, Möstl K, Radford AD, Thiry E, Truyen U, Horzinek MC. Sporotrichosis in cats: ABCD guidelines on prevention and management. J Feline Med Surg. 2013;15(7):619–623.

6.  Pennisi MG, Hartmann K, Lloret A, Ferrer L, Addie D, Belák S, Boucraut-Baralon C, Egberink H, Frymus T, Gruffydd-Jones T, Hosie MJ, Lutz H, Marsilio F, Möstl K, Radford AD, Thiry E, Truyen U, Horzinek MC. Cryptococcosis in cats: ABCD guidelines on prevention and management. J Feline Med Surg. 2013;15(7):611–618.

7.  Hartmann K, Lloret A, Pennisi MG, Ferrer L, Addie D, Belák S, Boucraut-Baralon C, Egberink H, Frymus T, Gruffydd-Jones T, Hosie MJ, Lutz H, Marsilio F, Möstl K, Radford AD, Thiry E, Truyen U, Horzinek MC. Aspergillosis in cats: ABCD guidelines on prevention and management. J Feline Med Surg. 2013;15(7):605–610.

8.  Lloret A, Hartmann K, Pennisi MG, Gruffydd-Jones T, Addie D, Belák S, Boucraut-Baralon C, Egberink H, Frymus T, Hosie MJ, Lutz H, Marsilio F, Möstl K, Radford AD, Thiry E, Truyen U, Horzinek MC. Mycobacterioses in cats: ABCD guidelines on prevention and management. J Feline Med Surg. 2013;15(7):591–597.

9.  Outerbridge CA. Cutaneous manifestations of internal diseases. Vet Clin North Am Small Anim Pract. 2013;43(1):135–152.