From:
Bruce Williams, DVM
Date: 2001-04-18 19:55:00 UTC
Subject: Re: Bob C: Playing the "Stump The Experts Game", or, Lookee
at Bear's Foot!
--- In Ferret-Health-list@y..., RRC <rrc961@m...> wrote:
> Just curious to see how many would be willing to go out on a limb,
> trying to diagnose something from a photograph.
>
> This left foot belongs to Bear, a 7 year old rescue from an Oregon
> petshop. Bear was neutered at 9 months old, and has been quite
healthy
> most of his life until two years ago when he presented symptoms of
> classic adrenal disease. During surgery, his left adrenal and part
of
> his right was removed and he recovered normally. Close to 1.5 years
ago,
> Bear began having problems with his left front foot; it would
> occasionally swell up as if someone had stepped on it. Maybe a week
> later, it would resolve on it's own. It was mentioned to my vet who
did
> a scraping (which came back with some undefined plasma cells, but
> nothing that could provide a definitive diagnosis), and he wanted to
> watch the foot until Bear had his second adrenal surgery (this time
> removing as much of the right adrenal as possible). During the
surgery,
> what was thought to be a large tumor (seen in x-ray and by
ultrasound)
> turned out to be a huge spleen (longer than Bear's entire body less
the
> tail; approximately 15 inches). It was removed. After the adrenal
and
> spleen surgery, and at my insistence, a full thickness slice of
skin was
> taken from the top of the foot. The biopsy was little help; either
the
> location of the biopsy was poor, or the handling of the tissue was
less
> than optimal, because a diagnosis could not be made, but a lot of
plasma
> cells were present.
>
> Treatments for the foot included four separate antibiotics; no
change.
> Two different anti-fungals; no change. Treatment with a topical
steroid;
> minor but short-lived improvement.
>
> Regardless of all attempts, Bear's foot has shown no sign of
> improvement. Usually it is enlarged like in the photo, hot to the
touch,
> but it doesn't seem to cause Bear pain when he walks on the paw.
> Occasionally the swelling goes down, but for the most part it
remains
> that ghastly purple-red color as seen in the photos. When cut or
> bruised, it can leak blood-tinged plasma. Bear is currently up to
date
> with all his shots for distemper and rabies, and has been since he
was a
> kit. To demonstrate the long-term unchanging character of the foot
> problem, the posted photos were taken last year, and because they
are
> virtually identical to how the foot looks now, I had no reason to
rephotograph.
>
> Currently Bear is diagnosed with moderate ascites secondary to
> cardiomyopathy, and is taking 0.3 ml Lasix (10mg/ml) and 0.2 ml
Lanoxin
> (= Digoxin) (0.05mg/ml). As a kit, Bear broke his right femoral
head,
> which healed more-or-less normally. He reinjured it twice, but
didn't
> refracture it. He has no other health problems, and recently caught
> influenza and recovered rapidly. He ambulates about as well as
someone
> with degenerative hips can walk, eats well, and his urine and blood
> tests come back within normal limits (for a guy missing his
spleen). He
> has no mental deterioration, and aside from his foot, baldness and
> ascites, he would look normal.
>
> The following suggestions have been made by various vets:
>
> 1. It is some type of allergic reaction.
>
> 2. It is some type of cancer.
>
> 3. It is a fungal disease.
>
> 4. It is a mystery disease.
>
> So, any ideas?
A couple more questions - is it only the one foot? Any chance of
getting the transcript of the histology report?
The appearance and location are most suggestinve of cutaneous
lymphoma, however, without a biopsy, I am hesitant to make a
definitive diagnosis. In some cases of lymphoma, especially in
deteriorated samples, neoplastic lymphocytes can appear lymphocytoid.
The restriction to only one foot argues against an allergic
reaction. While plasma cells may be seen with allergies, contact
dermatitis generally affects the contact surfaces, ie the bottom part
of the paw, not the top.
While a fungla infection usually affects only one foot, the cells of
import are not plasma cells, but macrophages.
At this point, I am thinking most about neoplasm here - lymphoma, or
possibly a vascular neoplasm such as lymphangioma or
lymphangiosarcoma.
At this point, a biopsy is the most definitive way to go, and any
other treatment modality is probably of little use. However, with
heart disease, it would be risky at best. Perhaps at necropsy, we
will get the answer. At any rate, I'd like to see a sample.
With kindest regards,
Bruce Williams, dVM