Monday, March 18, 2013

Eosinophilic Furunculosis - AKA Face Rot

I posted a photo a few days ago of Reiker's facial.. abnormality. It's been a long week, and I'll document it here in case it helps anyone in the future.

Reiker was eventually diagnosed with Eosinophilic Furunculoses. This condition is thought to be caused by a spider bite or bee sting, and is a sort of localized auto-immune reaction to a trigger. It's generally self limiting, and very easily treated with short term steroids. I read this paper and this brief article on the subject, and found them useful.

On Sunday, Feb 24, I let Reiker outside in the morning. I was looking out the glass door at him, and it looked like his face was stuck funny in his Gentle Leader. When I brought him in, I had a closer look and determined one cheek was swollen. Assuming an insect bite or something equally as benign, and since he wasn't bugging at it or showing any signs of discomfort, I gave him a Benadryl around 11am, and checked on him every couple hours. The swelling gradually decreased, and was basically gone by Monday morning.

I didn't see anything else until Wednesday morning. Once again, he had a bit of swelling on the top of his face. Nothing major, but strange. I immediately gave him half a Benadryl (all I had left) and again watched him carefully. He started out with just a bit of swelling, then developed a couple red spots. I assumed due to the location, that he had scraped/bonked his nose under the deck or under the shed.

This was taken Wed morning:
From Maligator

By Wed evening, it was looking a bit pustulated. He still wasn't showing any signs of discomfort. I held off on the Benadryl, as I didn't want to mask anything.

This was taken Wed evening:
From Maligator

Thursday morning, it looked basically the same. By Thursday afternoon, when I took him out to pee, it was open, terrible looking and ulcerated. We were heading to see a tech friend that evening, so I had her look at it. She recommended high doses of Benadryl, and to come in the next morning if it wasn't drastically improved.

Another tech friend saw the photos and immediately recognized it as EF. I mentioned this to the vets I saw, but until the biopsy came back, they were reluctant to consider it seriously.

Thursday night, I started Reiker on Benadryl, and washed his face up with Chlorhexadine scrub. And fed him Cheez Whiz for tolerating me. Lots of it.

Thursday Night's photos:
From Maligator

From Maligator

From Maligator


Friday morning, it was still getting worse. I called and got the only appointment left of the day. We saw the vet on Friday afternoon. He prescribed antibiotics, and booked a recheck for Wednesday in case it wasn't cleared up. I continued the Benadryl on my tech-friend's recommendation, and though the vet had recommended Metacam, I held off as I was still thinking he'd need steroids.

In the interest of giving the antibiotics time to work, Saturday came and went rather uneventfully.

Photos from Saturday morning, after three doses of antibiotics and benadryl:

From Maligator

From Maligator

From Maligator

And from Sunday night:

From Maligator

From Maligator

Sunday it was still getting worse, so Monday morning, I called the vet hoping to get in for Prednisone. The vet felt strongly that the biopsy needed to be done before he could prescribe the Pred, so we were booked in for Tuesday morning and instructed to "keep it clean for the next 24 hours".

Monday afternoon, things got bad. Reiker decided his face was itching terribly, and couldn't leave it alone. I tried distractions, muzzle, cone, sleeing with him,.. nothing helped. By 2am, I was exhausted from almost 12 hours of trying to keep him from it. I took the cone off, put him in his crate, and let him scratch until morning.

We were at the vet by 8:15 Tuesday morning. After talking to the Surgeon about my concerns around Reiker's dog/cat reactivity and ... enthusiastic nature, she agreed Dex/Torb premedication in the exam room would be best. I was happy overall with her anesthesia recommendations, and knew the tech personally. He was given IV premed, topped up with more IM, then once he was flat out, we took him to the back for induction and two biopsy punches. A stitch in each, and he was recovered. I left, and returned a few hours later.

I did not speak to the vet at this point, and was given steroids and buprenorphine with instructions. I was not instructed to continue the Benadryl, and was not given any further instructions around the antibiotics. I wasn't given any cleaning or wound care instructions except to bring him back in 14 days to have the stitches out. I asked if they could send me home with a blade to do it myself, and they easily agreed.

After one day of steroids, the photos show drastic improvement already:
From Maligator

The clinic called and had me pick up more antibiotics on Wednesday (one day of steroids). When I went to pick them up, I brought a list of questions and left them with the clinic staff. They were very happy to take my questions.

Two days later:
From Maligator

I spoke to the vet on the phone on day 2 (Thursday). She answered my questions, and I felt good about the information I was given.

When the biopsy results came back on day 4 (Saturday), I spoke to a third vet about the results. She explained it was EF, I explained I wasn't surprised. She encouraged me to continue the steroids a couple more days, and gave me more Buprenorphine as well. She also recommended giving him Benadryl again, so I started the benadryl then too.

Five days later:
From Maligator

Six days later (I think the cone came off at night around this point):
From Maligator

And ten days later, I stopped the steroids at this point due to some side effects (Cone was off permanently a day or so before this):
From Reiker 2

And today (13 days after the biopsy and he started the steroids). He was playing on the deck and opened up a tiny spot. This has happened a few times, it clots and I don't worry about it much.
I suppose I can take the stitches out any day now.
From Reiker 2

From Reiker 2

2 comments:

  1. Oh no, that sounds like a lot of stress for a little insect bite or whatever caused it. I never heard of Eosinophilic Furunculoses before. Is it going to happen every time he gets a bite or is it a one-time thing?

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  2. I just came to your post and reading above thing it is very impressive me and it is very nice blog. Thanks a lot for sharing this.
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    ReplyDelete