Oral lesions secondary to visceral leishmaniasis in a dog with endogenous hyperadrenocorticism: case report

ABSTRACT The objective of the present study was to report a case of visceral leishmaniasis with mucosal presentation in a dog with hyperadrenocorticism. A canine, male, Poodle, 11 years old, was attended with a history of dysphagia, halitosis, and sialorreia. The physical examination revealed generalized lymphadenomegaly and cutaneous alterations such as hair loss, comedones, telangiectasia, and cutaneous atrophy. Futhermore, the animal also had localized oral formations on the tongue. From the hematological and biochemical tests performed, the only alteration was alkaline phosphatase elevation (1724u / L). The low dose dexamethasone suppression test was performed to investigate hyperadrenocorticism and found a positive result. In addition, cytological exams of lymph nodes, bone marrow and oral formations were also performed, and the presence of amastigote forms of Leishmania sp. were observed in all samples. The animal was submitted to incisional biopsy of the oral formations and the histopathological analysis showed a granulomatous inflammation with presence of large quantity of microorganisms morphologically compatible with amastigotes forms of Leishmania sp. within the inflammatory cells. Faced with clinical findings and complementary exams, a case of leishmaniasis with atypical mucosal manifestation, associated with hyperadrenocorticism, was diagnosed, and this endocrinopathy could have been a predisposing factor to this infectious-contagious disease.

摘要 本研究旨在报告1例伴肾上腺皮质功能亢进症（hyperadrenocorticism）的犬出现内脏利什曼病（visceral leishmaniasis）黏膜表现的病例。一只11岁雄性贵宾犬（Poodle），因吞咽困难（dysphagia）、口臭（halitosis）及流涎（sialorreia）前来就诊。体格检查可见全身性淋巴结肿大（generalized lymphadenomegaly）及皮肤病变，包括脱毛（hair loss）、粉刺（comedones）、毛细血管扩张（telangiectasia）及皮肤萎缩（cutaneous atrophy）。此外，该动物舌部可见局限性口腔病灶。血液学及生化检查仅见碱性磷酸酶（alkaline phosphatase）升高（1724 U/L）。采用低剂量地塞米松抑制试验（low dose dexamethasone suppression test）排查肾上腺皮质功能亢进症，结果呈阳性。此外，还对淋巴结、骨髓及口腔病灶进行了细胞学检查（cytological exams），所有样本中均观察到利什曼原虫（Leishmania sp.）的无鞭毛体（amastigote forms）形态。对该动物的口腔病灶实施切开活检（incisional biopsy），组织病理学分析（histopathological analysis）显示肉芽肿性炎症（granulomatous inflammation），炎性细胞内可见大量形态与利什曼原虫无鞭毛体相符的微生物。结合临床发现与辅助检查结果，确诊为伴非典型黏膜表现的利什曼病，且合并肾上腺皮质功能亢进症，该内分泌疾病或为该传染性疾病的易感诱因。