{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T12:21:10Z","timestamp":1740140470049,"version":"3.37.3"},"reference-count":40,"publisher":"Akademiai Kiado Zrt.","issue":"3","funder":[{"DOI":"10.13039\/501100003725","name":"National Research Foundation of Korea","doi-asserted-by":"crossref","award":["2017R1D1A3B03028863"],"award-info":[{"award-number":["2017R1D1A3B03028863"]}],"id":[{"id":"10.13039\/501100003725","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["akjournals.com"],"crossmark-restriction":true},"short-container-title":["AVet"],"published-print":{"date-parts":[[2020,9,30]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>A 10-year-old, spayed female Shih Tzu dog presented with a history of progressive erythema and multiple crusts developing 85 days previously. The dog had been diagnosed with hyperadrenocorticism (HAC) 55 days prior to presentation and was treated with oral trilostane (2.86 mg\/kg, once daily) that was discontinued due to a poor response. In addition to generalised alopecia, erythematous plaques and crusts were noted on the trunk, head and footpads. Lesional impression smears revealed numerous acantholytic cells and non-degenerated neutrophils. Histopathological findings demonstrated subcorneal pustules with acantholytic cells and intact neutrophils. On the basis of these findings, we diagnosed pemphigus foliaceus (PF) with concurrent HAC. We wished to avoid glucocorticoids and, therefore, prescribed oral, once-daily azathioprine (2 mg\/kg), modified cyclosporine (7 mg\/kg) and ketoconazole (5 mg\/kg). By day 71 post-treatment, the erythematous crusts had almost disappeared and the alopecia had improved considerably. However, by the subsequent follow-up examination on day 99, the clinical signs had reappeared due to the tapering of cyclosporine. To the best of our knowledge, this is the first case report describing concurrent PF and HAC in a dog. Combination therapy with azathioprine, modified cyclosporine and ketoconazole was effective, and should be considered for dogs diagnosed with concurrent autoimmune diseases and HAC.<\/jats:p>","DOI":"10.1556\/004.2020.00047","type":"journal-article","created":{"date-parts":[[2020,11,23]],"date-time":"2020-11-23T03:00:32Z","timestamp":1606100432000},"page":"251-256","update-policy":"https:\/\/doi.org\/10.1556\/policypage.crossmark.crossref.1","source":"Crossref","is-referenced-by-count":1,"title":["Combination therapy with azathioprine, cyclosporine and ketoconazole in a dog with concurrent pemphigus foliaceus and hyperadrenocorticism \u2013 Case report"],"prefix":"10.1556","volume":"68","author":[{"given":"Taesik","family":"Yun","sequence":"first","affiliation":[{"name":"1Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, Chungbuk 28644, South Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yoonhoi","family":"Koo","sequence":"additional","affiliation":[{"name":"1Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, Chungbuk 28644, South Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sanggu","family":"Kim","sequence":"additional","affiliation":[{"name":"2Department of Veterinary Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, Chungbuk 28644, South Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hakhyun","family":"Kim","sequence":"additional","affiliation":[{"name":"1Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, Chungbuk 28644, South Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Soochong","family":"Kim","sequence":"additional","affiliation":[{"name":"2Department of Veterinary Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, Chungbuk 28644, South Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ji-Houn","family":"Kang","sequence":"additional","affiliation":[{"name":"1Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, Chungbuk 28644, South Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mhan-Pyo","family":"Yang","sequence":"additional","affiliation":[{"name":"1Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, Chungbuk 28644, South Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4471-4342","authenticated-orcid":true,"given":"Byeong-Teck","family":"Kang","sequence":"additional","affiliation":[{"name":"1Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, Chungbuk 28644, South Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"425","reference":[{"key":"ref51","doi-asserted-by":"crossref","first-page":"546","DOI":"10.1016\/S1590-8658(03)00270-6","article-title":"Combination immunomodulatory therapy with cyclosporine and azathioprine in corticosteroid-resistant severe ulcerative colitis: the Edinburgh experience of outcome","volume":"35","author":"Campbell","year":"2003","journal-title":"Dig. Liver Dis."},{"key":"ref21","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1016\/B978-1-4557-4456-5.00010-9","article-title":"Canine hyperadrenocorticism","volume-title":"Canine and Feline Endocrinology","author":"Behrend","year":"2015"},{"key":"ref231","doi-asserted-by":"crossref","first-page":"1292","DOI":"10.1111\/jvim.12192","article-title":"Diagnosis of spontaneous canine hyperadrenocorticism: 2012 ACVIM consensus statement (small animal)","volume":"27","author":"Behrend","year":"2013","journal-title":"J. Vet. Intern. Med."},{"key":"ref31","doi-asserted-by":"crossref","first-page":"1292","DOI":"10.1111\/jvim.12192","article-title":"Diagnosis of spontaneous canine hyperadrenocorticism: 2012 ACVIM consensus statement (small animal)","volume":"27","author":"Behrend","year":"2013","journal-title":"J. Vet. Intern. 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Assoc."},{"key":"ref281","first-page":"245","volume-title":"Small Animal Dermatology: A Color Atlas and Therapeutic Guide","author":"Hnilica","year":"2016"},{"key":"ref81","first-page":"245","volume-title":"Small Animal Dermatology: A Color Atlas and Therapeutic Guide","author":"Hnilica","year":"2016"},{"key":"ref151","doi-asserted-by":"crossref","first-page":"1826","DOI":"10.1002\/art.1780371219","article-title":"Cushing\u2019s disease-induced remission of severe rheumatoid arthritis","volume":"37","author":"Sen\u00e9cal","year":"1994","journal-title":"Arthritis Rheum."},{"key":"ref301","doi-asserted-by":"crossref","first-page":"189","DOI":"10.5326\/0420189","article-title":"Pemphigus foliaceus in 91 dogs","volume":"42","author":"Mueller","year":"2006","journal-title":"J. Am. Anim. Hosp. Assoc."},{"key":"ref111","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1016\/j.vetimm.2005.10.002","article-title":"Desmoglein-1 is a minor autoantigen in dogs with pemphigus foliaceus","volume":"110","author":"Olivry","year":"2006","journal-title":"Vet. Immunol. Immunopathol."},{"key":"ref11","first-page":"2456","article-title":"Improvement of systemic lupus erythematosus activity by the association of delayed onset Cushing\u2019s syndrome","volume":"25","author":"Arima","year":"1998","journal-title":"J. Rheumatol."},{"key":"ref01","first-page":"1795","article-title":"Hyperadrenocorticism in dogs","volume-title":"Textbook of Veterinary Internal Medicine","author":"Alenza","year":"2017"},{"key":"ref61","doi-asserted-by":"crossref","first-page":"821","DOI":"10.1083\/jcb.200105009","article-title":"Mice lacking desmocollin 1 show epidermal fragility accompanied by barrier defects and abnormal differentiation","volume":"155","author":"Chidgey","year":"2001","journal-title":"J. Cell Biol."},{"key":"ref201","first-page":"1795","article-title":"Hyperadrenocorticism in dogs","volume-title":"Textbook of Veterinary Internal Medicine","author":"Alenza","year":"2017"},{"key":"ref331","first-page":"2007","article-title":"Cyclosporine, ketoconazole and azathioprine combination therapy in three cases of refractory canine pemphigus foliaceus","volume":"220","author":"Rosenkrantz","year":"2007","journal-title":"North Am. Vet. Dermatol. Forum Proceed."},{"key":"ref71","doi-asserted-by":"crossref","first-page":"1312","DOI":"10.2460\/javma.2004.224.1312","article-title":"Outcome and complications associated with treatment of pemphigus foliaceus in dogs: 43 cases (1994\u20132000)","volume":"224","author":"Gomez","year":"2004","journal-title":"J. Am. Vet. Med. Assoc."},{"key":"ref361","doi-asserted-by":"crossref","first-page":"1498","DOI":"10.1111\/bjd.17591","article-title":"Clinical and immunological features of pemphigus relapse","volume":"180","author":"Ujiie","year":"2019","journal-title":"Br. J. Dermatol."},{"key":"ref141","first-page":"377","article-title":"Clinical evaluation of cyclosporine in animal models with cutaneous immune-mediated disease and epitheliotropic lymphoma","volume":"25","author":"Rosenkrantz","year":"1989","journal-title":"J. Am. Anim. Hosp. Assoc."},{"key":"ref221","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1016\/B978-1-4557-4456-5.00010-9","article-title":"Canine hyperadrenocorticism","volume-title":"Canine and Feline Endocrinology","author":"Behrend","year":"2015"},{"key":"ref211","first-page":"2456","article-title":"Improvement of systemic lupus erythematosus activity by the association of delayed onset Cushing\u2019s syndrome","volume":"25","author":"Arima","year":"1998","journal-title":"J. Rheumatol."},{"key":"ref381","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1046\/j.1365-3164.2002.00297.x","article-title":"Putative drug-related pemphigus foliaceus in four dogs","volume":"13","author":"White","year":"2002","journal-title":"Vet. Dermatol."},{"key":"ref131","first-page":"2007","article-title":"Cyclosporine, ketoconazole and azathioprine combination therapy in three cases of refractory canine pemphigus foliaceus","volume":"220","author":"Rosenkrantz","year":"2007","journal-title":"North Am. Vet. Dermatol. Forum Proceed."},{"key":"ref291","doi-asserted-by":"crossref","first-page":"1509","DOI":"10.1084\/jem.160.5.1509","article-title":"Human autoantibodies against a desmosomal core protein in pemphigus foliaceus","volume":"160","author":"Koulu","year":"1984","journal-title":"J. Exp. Med."},{"key":"ref311","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1016\/j.vetimm.2005.10.002","article-title":"Desmoglein-1 is a minor autoantigen in dogs with pemphigus foliaceus","volume":"110","author":"Olivry","year":"2006","journal-title":"Vet. Immunol. 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