Diagnosis of eosinophilic granuloma and methods of treatment. Bone changes in diseases of the reticuloendothelial system and hematopoietic organs Granuloma of the frontal bone

The most benign representative of the entire group of diseases of the reticuloendothelial system with the most gentle and mild course are the so-called eosinophilic bone granulomas.

In fact, they have long been known both in life and in the scientific literature, but were previously misinterpreted.

The priority in isolating this disease into an independent nosological form belongs to the Kazan pathologist N. I. Taratynov, who in 1913 for the first time in the world literature described a case of damage to the bones of the cranial vault in one patient. The surgeons made a presumptive diagnosis of gumma, tuberculosis, or traumatic cyst, but histological examination of the excised lesion revealed a solid mass of eosinophils. N. I. Taratynov perfectly understood the histological picture, correctly assessed his finding and made a fundamentally important conclusion that “there are granulomas that are clinically and macroscopically completely similar to tuberculosis, recognizable only histologically and consisting exclusively of eosinophils.”

Interest in bone eosinophilic granulomas has been especially revived due to the achievements of radiology since 1940, when a number of authors independently “discovered” this nosological unit. Eosinophilic granulomas are undeniably common. Our own experience is based on 45 observations.

Eosinophilic granulomas mainly affect children and young men, the favorite age is school. But we have to observe this disease in small children, and in the third and fourth decades of life. Males are at least 3-4 times more likely to get sick than females.

This disease is either solitary or multiple in the skeleton, and in about half of all cases, the bone foci are multiple, scattered in different places of the skeleton. With a dynamic x-ray examination, it is sometimes possible to follow their sequential appearance and development. In some patients, the number of nests scattered over the skeleton can reach several tens. Eosinophilic granulomas are very "illegible" in terms of location - there is not a single area of \u200b\u200bthe skeleton in which lesions have not been found at present. If earlier it was believed that eosinophilic granulomas do not occur in the bones of the hands and feet, now this position has been refuted thanks to the accumulated collective experience. Literally all types of bones are affected - large and small tubular bones, short and flat bones, spongy and compact structures. Most often, eosinophilic granulomas nevertheless nest precisely in the integumentary bones of the brain skull, in the ribs, in the pelvic bones, especially in the supraacetabular region, in the proximal half of the femur. It can be argued that, for some unknown reason, eosinophilic granulomas are preferentially located in such unusual places and in general in such bones of the skeleton, which in everyday bone pathology remain, as it were, “in the shade”. Such, for example, are the upper branch of the pubic bone and the symphysis region in general, the sacrum, scapula, the body of the epistrophy, the middle of the diaphysis of the fibula or one of the ends of the clavicle, the lower jaw, etc. thought on this diagnostic possibility, i.e., on the possibility of an eosinophilic granuloma.

Clinically, eosinophilic granulomas develop in boys who otherwise appear healthy. In a limited place, small or moderate independent pains appear, as well as pain on palpation. If the focus is located superficially, then swelling of the surrounding soft tissues is visible. The pains never become sharp, cruel, they are always quite tolerable. With some localizations of granulomas, for example, near the articular ends, functional disorders can naturally occur. The disease creeps up slowly, gradually, and it proceeds chronically, sometimes for a very long time. In some of the most benign cases, eosinophilic granulomas can generally be asymptomatic for years, and then a pathological fracture can serve as the first manifestation of the disease. We have repeatedly observed such pathological processes as mastoiditis, otitis media, this or that deformation of the brain or facial skeleton as the first external manifestation of eosinophilic granuloma. When a bone lesion ruptures from the supraacetabular region into the hip joint, a picture of coxitis may occur. The body temperature is either normal, or there may be subfebrile rises. The blood shows some slight generalized leukocytosis with a neutrophilic shift, as well as slight anemia. It is important that with eosinophilic bone granulomas, high eosinophilia in the circulating blood does not occur, the number of eosinophils usually varies within 4-10%. The general clinical picture of bone eosinophilic granulomas is poor even in cases where a large number of foci are found in the skeleton. Only rarely are bone changes combined with one or another manifestation of general xanthomatosis, which are described above. Such, for example, are bulging eyes, diabetes, or some kind of endocrine-vegetative disorder, a special type of gingivitis, skin rashes, up to and including ulceration. Therefore, we once again point out the need to understand this disease not from a formal standpoint, but we must always reckon with the possibility of transitional forms.

The etiology of eosinophilic granulomas has not yet been unraveled. Bacteriological examination always gives a negative result. The virus has not yet been isolated. The question of the helminthic nature of this disease is not unfounded, and this is all the more so since, along with bone changes, radiographically detectable pulmonary infiltrates similar to bone granulomas are described. The latter, however, are not similar to the usual volatile eosinophilic infiltrates in helminthic ascaris invasion.

The morphological picture of eosinophilic granulomas is very typical. This is a well-limited granulomatous-osteolytic process in the bone, often attracting attention already on the operating table with a yellowish-brown color of the tissue masses contained in the bone cavity. Histologically, a reticular, reticular base is determined, in which many eosinophils are found in groups, clusters and in a scattered form.

Rice. 347. Eosinophilic granulomas in a 38-year-old patient. Multiple destructive foci in the distal half of the femur. Histological confirmation of the diagnosis. A - direct radiograph; B - lateral radiograph.

The granuloma contains only few ordinary leukocytes, but there are mononuclear histiocytes, macrophages, plasma and giant cells, lymphocytes, and often typical foam cells. With general good vascularization, small hemorrhages and small necrotic areas are also described, in which Charcot-Leiden crystals are found, which were first noticed by N. I. Taratynov. Massive resorption of the bone substance occurs without sequestration.

The X-ray picture with eosinophilic granulomas has a number of very characteristic features (Fig. 347-349). It is based on a destructive focus of several centimeters of the veins.

Rice. 348. The same observation. X-ray of the pelvis. Lesions in the proximal end of the right femur and in the ascending branch of the left ischium.

mask, coming from the spongy substance, or rather, from the bone marrow, but quickly passing from the inside to the compact tissue and usually causing perforation of the compact

Bone defects are rounded, ovoid, or irregular in shape, as if punched out with a punch. Merging with each other, they necessarily retain their original elementary outlines, and we attach great diagnostic significance to their total nodular form, polycyclicity, or intercepted contours. Sometimes confluent defects retain the remnants of the bony septa and thereby acquire an unsharply pronounced cellular pattern. The circumstance that there is no reactive sclerosis of the bone edges of the defects is also of significant diagnostic value. Likewise, as a rule, there is no noticeable thickening of the cortical layer and periosteal growths, except perhaps only lesions in the ribs, which may be cylindrical or fusiform swollen.

Rice. 349.

Occurring in some cases, especially with lesions of tubular bones, a pathological fracture is distinguished by its benign course, it is usually without complications, heals quickly and well, and does not at all cloud the prediction of eosinophilic granulomas. The prognosis is generally quite favorable. There are known cases of independent, without any external medical influence, involutive course of the disease, self-liquidation of the pathological process, traced for 2-3 years on a series of radiographs. Therefore, at present, a reserved attitude towards surgical treatment, which was previously widely practiced, has developed, and indications for curettage of foci are being made less and less often. Under all conditions, lesions located near the joints or cavities of the human body should not be operated on. We, like all other authors, observe excellent results with the use of X-ray therapy, and only the rarest cases of eosinophilic granulomas can be classified as resistant to the action of ionizing radiation. For the sake of scientific objectivity, let's say that when evaluating the effectiveness of X-ray therapy, we must not forget the above-mentioned ability of eosinophilic granulomas to the so-called spontaneous treatment.

We also point out here that an eosinophilic granuloma of the vertebral body can clinically and radiologically proceed as a symptomatic Calve osteochondropathy, i.e., the destruction of the spongy substance of the vertebral body by a specific granuloma entails a pathological fracture with the formation of a darkened “flat vertebra” and subsequent complete restoration of both the shape and and the structural pattern of this vertebra, mainly in childhood.

Thus, radiographic symptomatology should be regarded as sufficiently indicative and convincing in diagnostic terms, and when familiarized with clinical and radiological parallels in eosinophilic granulomas and with some experience, the diagnosis does not present any particular difficulties. Nevertheless, the final and decisive significance for recognition still remains in each individual case only with microscopic examination. This is unfortunate, because in essence, surgical intervention, as already mentioned, is not at all necessary for treatment, and without special need one does not want to resort to a biopsy. That is why we are developing the method of bone puncture in such a way, which here turns out to be practically quite sufficient in all respects. We fundamentally, unless there are vital indications, do not take a patient for X-ray therapy without an impeccably justified accurate diagnosis, and it is with eosinophilic granulomas that it would be easier and best of all to immediately resort to X-ray therapy after an X-ray diagnosis of the disease.

In the differential diagnosis of eosinophilic granulomas, it is necessary first of all to take into account all of the above in relation to xanthomatosis. It is clear that distinctive recognition is rich and varied. Inflammatory processes are of the greatest practical importance - atypical forms of osteomyelitis, granulation tuberculous foci, gummous syphilis, all cystic lesions, especially a limited bone cyst and giant cell tumor, and of true tumors - Ewing's tumor, osteogenic sarcoma, chondroma, chondroblastoma, chondrosarcoma, endothelial neoplasms, myeloma, solitary and multiple metastatic bone tumors. We observed a case of eosinophilic granuloma of the proximal third of the humerus in a 2-year-old child with severe bone swelling, destruction of the cortical layer and even the formation of periosteal spinous growths, which radiologically could not be distinguished from a malignant neoplasm, and only histological examination clarified the recognition. In another case of diagnostic error, eosinophilic granuloma also simulated a focus of fibrous dysplasia in the tibia in early childhood. The smaller the child, the more the eosinophilic granuloma deviates from the usual picture and the more differential diagnostic difficulties increase.

Orthopedist-traumatologist of the first category, Research Institute, 2012

Eosinophilic granuloma is a benign formation with a large number of infiltrates inside. They are produced due to an increase in the level of eosinophilic leukocytes. Statistics show that this disease is diagnosed extremely rarely. In the vast majority of cases, it occurs in men.

You can recognize eosinophilic granuloma by single or multiple formations on the skin of the face, on internal organs, in tubular or flat bones. A neoplasm on the face occurs mainly in men, in bone tissue - in children.

Despite the achievements of modern medicine, the exact reasons why eosinophilic granuloma occurs have not been established. Specialists cannot fully study the mechanism of development of this pathology. It has been proven that the bites of some insects can accelerate the course of the disease.

Predisposing factors for the occurrence of pathology are:

Infectious diseases;
Bone injuries;
Damage to the integrity of the skin;
Bites of some insects and spiders;
Hypersensitivity of the body to certain components;
Taking a number of medications;
genetic predisposition;
The presence of frequent attacks of exacerbation of allergic reactions.

Many experts are of the opinion that eosinophilic granuloma is a harbinger of a tumor or hyperplastic process. If you have been diagnosed with this pathology, you must undergo an extended study and adhere to drug therapy. This will help reduce the risk of complications in the future.

Features of the course of the disease

Statistics show that in most cases, eosinophilic granuloma is diagnosed in children of school and preschool age. Despite this, it can occur in any person. The course of this pathology does not manifest itself with any distinctive symptoms - serious changes occur in the bones, while the person does not feel any signs.

In the initial stages, the only thing that makes it possible to suspect an eosinophilic granuloma is a slight soreness and inflammation at the site of the lesion.

Doctors believe that the bones of the lower jaw and skull are the favorite places for the formation of the disease.

Eosinophilic granuloma can be diagnosed by radiographic examination. On it, it is possible to notice small defects in the bones - they have an oval or rounded shape. In this case, the lesion does not always affect the internal organs.

Eosinophilic granuloma does not affect the work of the body, the body temperature remains normal, there are no signs of general etching of the body. The chemical composition of the blood may change: the erythrocyte sedimentation rate increases, thrombosis occurs.

The most accurate method for determining the disease is a bone marrow puncture - there are polynuclear cells in the fluid.

With eosinophilic granuloma of the skin, small hemorrhagic papules appear. They bleed into the center, while the surface of such formations is covered with a dense crust. It is possible to meet such protrusions on the skin of the face or scalp. Much less often, pathology is diagnosed on the trunk or legs.

To prescribe an effective treatment, it is necessary to differentiate eosinophilic granuloma from Schüller-Hand disease. EG may be accompanied by diabetes insipidus, enlarged lymph nodes, liver and spleen. In Schüller-Hand disease, children are often diagnosed with a deviation in physical development.

Symptoms

Diagnosing eosinophilic granuloma is quite difficult - it manifests itself as blurred signs that may indicate various diseases. Eosinophilic bone granuloma can be diagnosed during an exacerbation or in advanced stages.

In this case, the disease manifests itself:

In the presence of a neoplasm in the spinal column, the patient may complain of pain in the back, limited mobility, and excessive contraction of the tendons in the feet. Usually these symptoms do not go away within 3-4 months.

It is extremely difficult to diagnose a deviation, the disease is rare, and the experience of its treatment is rather small.

With insufficient examination, eosinophilic granuloma can easily be confused with the following diseases:

Rheumatism is a bone disease that affects the cardiovascular system;
Leukemia is a malignant process that suppresses the production of red blood cells;
Bone tuberculosis is an infectious disease that affects the spinal cord;
Meningoradiculitis - inflammation of the lining of the spinal cord;
Osteomyelitis is a purulent process that develops in bone tissue;
Osteosarcoma is an extremely rare disease;
Lymphogranulomatosis - a malignant process in the lymph nodes;
Fibrous osteodystrophy is the replacement of bone tissue with fibrous fibers.

Stages of eosinophilic granuloma

Eosinophilic granuloma is a poorly understood disease. According to recent data, the course of pathology can be divided into three stages. To determine exactly what degree of damage the patient has, he is sent for an X-ray examination.

The first stage is characterized by the formation of an eosinophilic granuloma, the second - the formation of flat vertebrae, the third - the appearance of a pathological spine.

The stages of degenerative changes in bone tissue can be described as follows:

First stage. At this stage, serious pain appears in the human spine. The patient complains of constant weakness and fatigue, he is tormented by malaise and fever. The erythrocyte sedimentation rate increases, with visual examination and palpation of the spine, the processes are perfectly palpable. In some cases, a doctor can diagnose kyphosis and scoliosis. Due to inflammation of the muscle tissue, the doctor can diagnose a swollen abscess. In the absence of full treatment, numerous foci of destruction appear in the spine.
Second stage. This degree of damage is characterized by a serious weakening of the spine, numerous microfractures are diagnosed in the column. Because of this, there are foci of hemorrhage. If left untreated, the spine can flatten by several millimeters. Compression of the spinal cord develops, due to which the person experiences discomfort that radiates to the thoracic region. The duration of this stage of development of pathology is about a year.
The third stage is the longest period, which can last up to several years. The height of the spine may lose about 2/3. In the posterior sections of the spine, the plates are compacted.

Diagnostic methods

Eosinophilic granuloma is difficult to diagnose. This disease is poorly understood by specialists, which is why it is often confused with other pathologies. To accurately determine this pathology, it is necessary to conduct the following studies:

Radiography is an examination with which it is possible to accurately determine the location of the pathological process. It will also help determine the size of the formation, the presence of processes;
Histological examination - the study of biological material taken from the spine. With its help, it is possible to determine the composition and structure of granulomas. With EG, it should contain eosinophils and histiocytic cells;
Complete blood count - may show an increase in the erythrocyte sedimentation rate, an increased level of leukocytes.

Treatment of pathology

The method of therapy for eosinophilic granuloma is selected individually. The doctor needs to conduct an extended diagnostic examination in order to diagnose this pathology as soon as possible. Quite often it occurs in children in the brain - in this case, no therapeutic measures are taken, expectant tactics are used.

In the vast majority of cases, their disease resolves on its own, without any therapy.

For the treatment of adults, it is necessary to carry out the following activities:

To get rid of the eosinophilic granuloma located on the skin of the face, the following measures are taken:

Electrocoagulation - the impact on the neoplasm with electrical impulses that activate its internal destruction;
The use of a carbon dioxide laser - a special gas is introduced into the bubble, which destroys its structure;
Cryotherapy - the impact on the neoplasm of low temperatures;
Surgical curettage is the most radical method of treatment, in which the neoplasm is simply excised from the surface of the skin.

To get rid of eosinophilic granulomas localized in the bone tissue, a resection is performed. To fully recover from this disease, doctors perform plastic surgery or transplantation of the skin from other parts of the body.

In some cases, chemical or radiation therapy is indicated to exclude recurrence.

Exact preventive recommendations have not been developed - experts do not know what causes can provoke the development of this disease. With timely started and complex treatment, a positive outcome is diagnosed in 90% of cases.

Eosinophilic granuloma of bone affects children, adolescents, and young adults (mainly under 30 years of age) and occurs slightly more frequently in men than in women.

Histology and pathogenesis of eosinophilic granuloma of bone

Eosinophilic granuloma of bone is one of the nosological forms related to PCH (formerly histiocytosis X), accounting for approximately 70% of its cases. EG is the most benign flowing form of LCH, limited, as a rule, only to the bone skeleton. Two other forms, Letterer-Siwe disease and Hand-Schuller-Christian disease (bone xanthomatosis), affect children and are covered in specific guidelines. All three forms are based on a single pathological process. A specific morphological feature of this group of diseases is the presence in the lesions of Langerhans cells - histiocytes with characteristic inclusions in the cytoplasm (Langerhans granules), detected by electron microscopy.

The process begins with the proliferation of histiocytes, which directly carry out bone resorption.
Then the medullary spaces are infiltrated by eosinophilic leukocytes with an admixture of neutrophilic leukocytes, lymphocytes and giant cells (granuloma stage).
During the period of reverse development, clusters of xanthoma cells often appear.

All three stages can be presented simultaneously in the same lesion, and eosinophils are rarely absent. The etiology of LCH is unknown, many authors consider it as a manifestation of the pathology of the immune system.

In 70-80% of cases of EG there is a single focus of bone tissue destruction, in the rest there are multiple foci. The skull, lower jaw, spine, ribs, pelvis, long bones are most often affected. In adults, lesions of flat bones predominate. In the skull, the foci are localized mainly in the scales of the frontal bone and in the parietal bones, in the spine, as a rule, in the bodies of the thoracic and lumbar vertebrae. In long tubular bones, changes occur in the diaphysis and metaphyses, the epiphyses are rarely affected and mainly in children. EG is also found in the sternum, clavicles, and short tubular bones.

The size of the foci of eosinophilic bone granuloma can increase over a short period of time, and the "sequester" resolves. But usually the dynamics after the detection of the focus of EG is expressed in a decrease in its size, the appearance of osteosclerotic edging or bone septa inside the focus. When long tubular bones are affected, periosteal layers are assimilated with a thickening of the cortical layer, and after some time a surprisingly complete restoration of the shape, thickness and structure of the bone occurs. In young children with a picture of vertebra plana, the height of the vertebral bodies is also restored. The younger the patient, the more perfect the recovery can be. As a rule, all this happens without any treatment. Most likely, this is why a variety of methods of therapy “help”: radiation therapy, chemotherapy, or the recently popular introduction of glucocorticoids into the focus after a biopsy. Treatment is necessary in rare cases in patients with very severe pain, with the threat of a pathological fracture, the development of instability after a pathological fracture of the vertebrae, or rare neurological disorders. However, the healing of bone foci does not always mean a cure, as in some patients new foci appear, and extraskeletal changes join them. As a rule, this occurs within 1-2 years after the appearance of the first focus and sometimes lasts up to 10 years.

Symptoms and diagnosis of eosinophilic granuloma of bone

Clinical examination

Eosinophilic granuloma of bone may be asymptomatic or present with localized pain and swelling. However, the general condition of patients in this case suffers relatively little, and the pain rarely reaches great intensity and may be absent altogether. Thus, a discrepancy between significant morphological (radiological) changes and mild clinical manifestations is characteristic. Neurological disorders are rare in spinal cord injury.

Radiation diagnostics

The X-ray picture is characterized by destructive changes and depends on the localization. In flat bones, the destruction focus is clearly defined and has an oval shape. Often the shape of the focus is more complex, and the outlines are polycyclic, which indicates its multicentric origin. The focus penetrates compact plates (outer), usually over a larger extent, and protrudes into the integumentary soft tissues, causing their local thickening. The unequal extent of the destruction of the outer and inner compact plates of the bones of the cranial vault is often displayed as a doubling of the contours of the focus - a symptom of a "cavity in the cavity" (Fig. 4.24). The sclerotic rim along the periphery of the focus is usually absent. In the center of the destructive focus in the bones of the cranial vault, a section of preserved bone tissue can be seen - the so-called bellied sequester. Sometimes the picture is supplemented by the presence in the neighborhood of smaller destructive foci (satellite foci). When the jaw is damaged with the localization of the focus near the roots of the tooth, a “floating tooth” pattern may occur.

In the diaphysis and metaphyses of long bones, a centrally located, relatively well-demarcated destructive focus is found, causing arcuate defects along the endocortical surface of the compact substance with its local thinning. Often there are also indications of multicentricity (scalloped outlines, satellite foci). This localization is characterized by a linear or layered periosteal reaction. Sequesters are not observed.

In the spine in children, a picture of the vertebra plana appears - a flattened vertebral body up to the convergence of the upper and lower end plates with almost complete destruction of the spongy substance. The process can go to the legs of the arc. The intervertebral discs are not narrowed, on the contrary, their height often increases. Paravertebral soft tissues may be thickened due to the soft tissue component of the granuloma itself and due to edema accompanying pathological compression of the vertebral body.

An important task of the doctor is to clarify the prevalence of the lesion. Sometimes the identification of asymptomatic lesions with a typical picture allows us to decipher the nature of the initially identified atypical focus. In addition, it is useful to have a complete baseline to follow the course of the disease. Bone scintigraphy cannot be a screening method, as it is less sensitive than radiography in detecting bone foci of EG. There are a number of reports of false-negative results of this method, which is explained by the purely destructive nature of the disease. Screening for eosinophilic granuloma of bone by whole-body MRI is not available on most CT scanners. Therefore, in practice, the most acceptable method is a combination of radiography of the skull, pelvis, chest organs, femurs and humerus bones in at least one projection and MRI of the spine (T1-weighted or STre-image). Of course, any part of the body, from which there are at least the slightest clinical manifestations, should also be subjected to visualization.

On MRI, the signal of eosinophilic bone granuloma is nonspecific: it is isointense to muscle on T1-weighted image and hyperintense on T2-weighted image. There is swelling of the surrounding bone marrow, and when localized in long tubular bones, there is also swelling of the paraosseous soft tissues. The signal of the lesion, as well as areas of reactive edema, is enhanced after contrast enhancement.

Differential Diagnosis

Since the X-ray picture in Hand-Schuller-Christian disease consists of the same elements, it is not always easy to distinguish between both forms, especially in children. But in some cases and in adult patients, a bone lesion, typical in terms of symptoms and course for eosinophilic granuloma of the bone, is accompanied by pulmonary changes or diabetes insipidus, which indicates the artificiality of isolating the nosological division of LCH and the presence of intermediate forms.

Differential diagnosis of a solitary focus of eosinophilic bone granuloma in flat bones is carried out with myeloma (different age, clinical and laboratory data), hemangioma, FD, and in long bones - with inflammatory diseases, Ewing's sarcoma, lymphoma. The x-ray picture is most often quite revealing, although it is sometimes difficult to distinguish EG from Ewing's sarcoma. Multiple skeletal lesions must be differentiated from myeloma, cancer metastases, lymphoma, hyperparathyroid osteodystrophy, FD, and Gaucher disease.

Any owner of a domestic cat wants his animal to live a long life and not get sick. That is why he must be guided in the symptoms of diseases and know in which cases he should consult a doctor. Among the inflammatory processes is eosinophilic granuloma in cats, which can be caused by special cells in the animal's body - eosinophils, related to leukocytes and performing the role of immune defense.

Description

Granuloma is a lesion of the mucous membranes and the outer integument of the animal. Also in the literature you can find the names "eosinophilic granuloma complex", "eosinophilic dermatosis". Most often, young cats (age about 3.5 years) are susceptible to this disease, regardless of breed or gender.

Manifestations

In veterinary medicine, it is customary to distinguish several varieties of feline granulomas, which differ in localization and manifestation features:

ulcers. They are located on the tongue or upper lip of the cat, gradually increase in size and have a bright red color. The lip itself swells, the lesion captures the skin and mucous membrane. The initial size of such an ulcer is no more than 2 mm, but if treatment is not started in time, it will grow strongly and become more than 5 cm. does not cause pain. Most often, the ulcer has slightly raised edges, does not bleed. It is more typical for cats than for cats.
plaques. This variant of the granuloma affects the hips, groin or abdomen of the pet, accompanied by severe itching. Inside each plaque is a fluid that leaks out when the cat scratches the lesion, corrodes the skin and causes pain. It is also possible to detect such a manifestation of the eosinophilic granuloma of a cat during a visual examination: there is swelling at the site of damage, it is red and about 3-5 cm high. The surface of the lesion is shiny, the hair does not grow on them. Can occur in animals of any gender.
Plaque. It is the formation of small bald patches, painted red, often ulcers form on their surface. It affects the back, neck, hips of the pet, but can also be found on other parts of the body. Often accompanied by itching.

The granuloma can also be located on the paws of cats, on the chin, in the oral cavity, on the abdomen or sides.

Causes

Various factors are capable of causing the development of a granuloma in a cat or cat, the most common ones include:

Individual sensitivity of cats to a medical preparation.
Allergic reactions.
Hypersensitivity to airborne allergens.
hereditary factor.
Dermatitis resulting from the defeat of the animal by fleas or ticks, mosquito bites.

Also, the root cause of the disease can be individual food intolerance. Often, a granuloma can occur when a new type of food is introduced into the diet of an animal, when it accidentally consumes household chemicals, or when taking a medication. However, many veterinarians report that not all causes of granuloma dangerous for pets are understood and studied.

Symptoms

The symptoms of eosinophilic granuloma are varied. These include:

Tissue swelling.
The formation of dense nodules or small sores on the skin.
Skin lesions are most often isolated.
Acne (papules), nodes, plaques appear in the animal's oral cavity - in the palate or tongue, which prevent normal swallowing. This phenomenon is called dysphagia, it leads to chronic starvation of the cat and can cause serious complications, up to liver lipidosis.
Sometimes seals appear, accompanied by itching, but not causing pain.
Lymph nodes in cats are enlarged.

Most often, an animal with a granuloma does not betray its anxiety, behaves as usual, especially if the inflammation is just beginning and does not cause itching. Therefore, the owner is required to be attentive to his pet.

Having found at least one of the manifestations of a granuloma, you should immediately visit a veterinarian and begin treatment, because the sooner this is done, the more chances a cat has for a successful outcome without complications.

Diagnosis and treatment

Treatment of eosinophilic granuloma in a cat most often begins with a course of antibiotics. Taking such drugs is not aimed at eliminating the root cause, but at improving the condition of the animal, the duration of the course is determined by the veterinarian individually, but most often it is 3-4 weeks. The following drugs may be prescribed:

Doxycycline (every 12 hours give 5-10 mg).
Cyclosporine. Injections are made once a week for a month, the dose is calculated individually - 1 mg per kg of the cat's weight.

To relieve severe itching with granuloma, glucocorticosteroids are prescribed, they also quickly relieve inflammation. However, if an allergic reaction caused the granuloma, then such drugs can only increase its manifestation and worsen the pet's immunity. That is why taking this or that medicine on your own is unacceptable, only a specialist can determine the treatment.

Wound healing in cats with granuloma is stimulated by the drug methylprednisolone acetate or prednisolone, which are used until the skin is completely healed. Often, the reception of funds can be delayed for several months, but relief will be noticeable after 30 days of use. The dosage for granuloma is determined by the veterinarian individually, but the following amounts are most often used:

Methylprednisolone acetate in the form of subcutaneous injections - 4 mg per kg of cat weight (every 2-3 weeks).
Prednisolone - 2 mg per kg of body weight (every 12 hours).

When the wounds pass, prednisolone is completed, but not immediately, but gradually reducing the dose, this will avoid recurrence of the granuloma. If contact with the allergen cannot be prevented or the allergen itself is not detected, then methylprednisolone is continued, but the dosage of the drug becomes the lowest possible - once every 2-3 months.

Antihistamines are prescribed to eliminate allergy symptoms. It is important to identify the allergen and prevent it from affecting your pet, so your veterinarian may suggest a special diet.

There are situations when eosinophilic plaques are unresponsive to prednisolone. In this case, the veterinarian may prescribe other drugs.:

Dexamethasone - every 24 hours, ingestion of 0.4 mg per kg of the cat's weight.
Triamcinolone - every 24 hours, ingestion of 0.8 mg per kg of the cat's weight.

When the eosinophilic plaques have healed, the medication is reduced, the goal is to achieve the minimum effective dose (taking the drug after 2-3 days, not more often).

Forecast and prevention

Most often, the disease is treatable and resolves without serious complications. But it is very important to start therapy in a timely manner, this will increase the chances of a favorable outcome. When contacting a veterinarian at an early stage, there is a chance that you can limit yourself to taking only prednisolone, without antibiotics and antihistamines. If the disease is started, then the treatment of eosinophilic granuloma in a cat will be longer and more difficult, and the infection itself can even lead to the death of the animal.

However, it should be remembered that the best treatment for eosinophilic granuloma is prevention, so it is very important to develop a healthy and safe “menu” for the animal, the components of which will not cause allergies. A consultation with an allergist-veterinarian will help to do this.

Eosinophilic granuloma of domestic cats is one of the inflammatory processes of the mucous membranes and skin. Despite the fact that the clinical forms are quite diverse, these processes have in common what causes their allergic reactions, most often to food, a previously prescribed medication, or to an insect bite - a tick, a flea, a mosquito.

Veterinarian

Text of article from A Color Handbook of Skin Diseases of the Dog and Cat 2009

Translation from English: veterinarian Vasiliev AB

Etiology and pathogenesis

The eosinophilic granuloma complex appears in three main forms: eosinophilic or collagenolytic granuloma, eosinophilic or flaccid ulcer, and eosinophilic plaque. They have distinct clinical and histological features. The eosinophilic granuloma complex, however, is not a specific diagnosis and these lesions may represent different manifestations of responses to the same underlying causes. One cat may have a combination of different lesions.

The etiology of these dermatoses remains unknown. Local, uncontrolled accumulation of eosinophils leads to the release of inflammatory mediators, which trigger the mechanism of a permanent inflammatory process. Various conditions (see below) are associated with lesions characteristic of eosinophilic granuloma complex, but many cases are idiopathic. Lesions characteristic of eosinophilic granuloma complex have also been found in cats without specific pathogens, with exclusion of atopic dermatitis and food hypersensitivity, in whom no underlying cause has been established. Norwegian Forest cats may be predisposed.

Clinical features

Eosinophilic or collagenolytic granuloma

Lesions may be single or grouped, nodular, linear or papular, and may be located in any part of the body. Linear lesions are often located on the medial parts of the forepaws and caudal parts of the thighs. There is a distinct shape associated with the chin and lower lip, which may wax and wane. The dorsal part of the nose, the auricles, and the pads of the fingers are also often affected. The lesions are usually erythematous and alopecia, raised above the skin surface, and are knot-shaped or elongated or cord-shaped. Erosions, ulcers and necrosis can also be observed with the presence of pale rough foci (photo 1.2).

This distinctly seasonal pruritic dermatitis is associated with insect bites. Clinical signs include a particular, erosive to ulcerative crusting dermatitis of the nose, muzzle, auricles, parotid region, flexor wrist region, and junction of the pads of the fingers and altered skin. (photo 3) Chronic lesions may be depigmented. Injured fingertips may be ulcerated, swollen, and hypopigmented. Peripheral eosinophilia and pronounced peripheral lymphadenopathy may be observed.

Eosinophilic plaques

They are well-circumscribed, ulcerated, moist lesions typically found on the ventral abdomen, medial thighs, or caudal trunk. (Photo 4). There may also be lesions on the balls of the fingers (Photo 5) and, rarely, on the auricles (Photo 6). There is no breed or sex predisposition, although young cats may be predisposed. Adjacent lesions may coalesce, presenting as very large, plaque-like areas. Eosinophilic plaques are usually associated with pruritus, although this may not be apparent from the history.

Eosinophilic or flaccid ulcers

They are well-demarcated unilateral or bilateral ulcers occurring in the philtrum of the upper lip or near the upper canine. (Photo 7). The periphery of the ulcer is elevated and surrounds the pinkish to yellow center of the ulcer. Large lesions can be very destructive and deforming, but the lesions do not appear itchy or painful. Unlike other abnormalities characteristic of the eosinophilic granuloma complex, eosinophilia may not be the dominant finding on cytology or histopathology, and peripheral eosinophils are rare.

Differential diagnoses

Differential diagnoses can vary greatly depending on the clinical presentation, although many lesions in eosinophilic granuloma complex have a very characteristic appearance. Possible differential diagnoses include:

Injury
Radiation dermatitis
Skin neoplasia, especially squamous cell carcinoma
Bites from rodents and cats
Cat pox
calicivirus or infection
mycobacterial infection
Deep fungal infection
Immune-mediated diseases (pemphigus foliaceus, cutaneous lupus)

It is also important to eliminate any potentially disease-causing causes, then the idiopathic nature of the pathology can be assumed. Possible reasons include:

Treatment

The prognosis and long-term treatment depends on the cause that triggered this condition. However, many cases are idiopathic and require symptomatic treatment. Symptomatic treatment may also be necessary to control exacerbations in long-term treated animals. Certain lesions, especially flaccid ulcers, may be refractory to treatment. Some lesions, especially linear granulomas in young animals, may resolve spontaneously. Essential fatty acids and antihistamines have been reported to be helpful, especially if allergy is suspected as the trigger, although stronger treatment may be needed initially to get remission of the skin lesions.

Most cases will respond to systemic prednisolone (2 mg/kg once daily) or methylprednisolone (0.8 x per prednisolone dose). Once remission is achieved, the dose can be reduced to a maintenance dose given every other day. Some cats may respond better to dexamethasone (0.15 x per prednisolone dose) or triamcinolone (0.25-0.8 x per prednisolone dose), especially in the initial phase of treatment, although there are no drugs licensed for cats. Treatment may be continued with prednisolone or methylprednisolone for maintenance treatment, or doses may be reduced to maintenance doses once every 3 days. Depot methylprednisolone injections (every 2–4 weeks until remission, then every 6–8 weeks for maintenance treatment) are best reserved for cats that cannot be treated by oral administration. Intralesional injections of triamcinolone may be useful in solitary, well-demarcated lesions.

Surgical excision, cryosurgery, laser surgery, and radiation are recommended for solitary, well-demarcated lesions refractory to medical treatment. This is often successful, especially for flaccid ulcers, although recurrence is common.

Immune correction with recombinant feline omega interferon or recombinant human alpha interferon (30-60 IU/cat PO 24 hours for 30 days) is successful in some cats, although lesions recur after therapy ends.

Photo 1,2 Collagenolytic (eosinophilic) granuloma. Linear shape (Photo 1) and localized shape on the lower jaw of a cat (Photo 2).

Photo 3 Eosinophilic granuloma complex. Hypersensitivity of cats to insect bites

Photo 4 Eosinophilic granuloma complex. Eosinophilic plaque on the ventral abdomen in a cat

Photo 5 Eosinophilic plaque in the skin of the interdigital spaces

Photo 6 Eosinophilic plaques, erosions and crusts on the vertical part of the ear canal

Photo 7 Flaccid ulcer

Photo 8 Eosinophilic plaque in a cat. A large, bald, erythematous, eroded lesion with moist exudate is typical of this disease. Note that localization is atypical.

Photo 9 Eosinophilic plaque in a cat. A bald, erythematous lesion with moist exudate on the distal front paw of a cat. This eosinophilic plaque was caused by allergic dermatitis.

Photo 10 Eosinophilic plaque in a cat. These multifocal erosive plaques on the abdomen were intensely itchy. Note the marked intensity of erythema and moist exudate typical of this syndrome.

Photo 11 Eosinophilic plaque in a cat. Multiple small erythematous plaques with alopecia on the abdomen of a flea-allergic cat.

Photo 12 Eosinophilic plaque in a cat. Large eosinophilic plaque on the shoulder blade of a cat allergic to flea saliva.

Photo 13 Eosinophilic plaque in a cat. Close view of the lesion in Photo 19. A bald, erythematous, erosive lesion and moist exudate are typical of this disease.

Photo 14 Feline eosinophilic granuloma. Tissue swelling and erythema on the lower lip in a cat. Note the similarity to the flaccid ulcer commonly found on the upper lip.

Photo 15 Feline eosinophilic granuloma. Thickened linear area of alopecia and erythema on the caudal part of the hind paw. Inflammation associated with a linear eosinophilic granuloma creates a distinctly palpable lesion.

Photo 16 Feline eosinophilic granuloma. Circular eosinophilic granuloma on the hind paw of a cat.

Photo 17 Feline eosinophilic granuloma. Multiple confluent granulomas on the hard palate in a cat with flea allergy.

Photo 18 Feline eosinophilic granuloma. These large, confluent granulomas developed over several weeks. The cat had difficulty chewing, necessitating aggressive medical treatment.

Photo 19 Feline eosinophilic granuloma. Eosinophilic granuloma of the hard palate in an adult cat.

Photo 20 Flaccid ulcer. Severe tissue destruction of the upper lip caused by a severe ulcerative lesion in a cat with flea allergy.

Photo 21 Flaccid ulcer. Close-up view of the cat in photo 27. Severe tissue destruction and an ulcer of the upper lip are evident. The entire upper lip in the region of the nasal planum is destroyed.

Photo 22 Flaccid ulcer. Alopecia and upper lip ulcer in a cat.

Photo 23 Flaccid ulcer. Close-up view of the cat in Photo 29. Obvious tissue destruction and upper lip ulcer.

Photo 24 Flaccid ulcer. A bald, erythematous lesion with marked tissue edema and ulceration of the upper lip is characteristic of this disease. Lesions on the chin are atypical for this syndrome and are more characteristic of eosinophilic granuloma.

Photo 25 Flaccid ulcer. Tissue swelling and ulceration of the upper lip are characteristic of a flaccid ulcer.

Photo 26 Flaccid ulcer. Same cat in photo 25. The lesion looks mild with slight alopecia and swelling.

Text of the article and photo 1-6 from the book

A Color Handbook of

Skin Diseases of the

BSc, BVSc, PhD, CertVD, CBiol, MIBiol, MRCVS

Senior Lecturer in Veterinary Dermatology,

University of Liverpool Small Animal Teaching Hospital, Leahurst Campus, Neston, UK

Richard G Harvey

BVSc, PhD, CBiol, FIBiol, DVD, DipECVD, MRCVS

Godiva Referrals, Coventry, UK

Patrick J. McKeever

Professor Emeritus

McKeever Dermatology Clinics, Eden Prairie, Minnesota, USA

photo 7-26 from the book

A COLOR ATLAS AND THERAPEUTIC GUIDE

KEITH A. HNILICA, DVM, MS, DACVD, MBA

Pet Wellness Center

Allergy and Dermatology Clinic

Knoxville, Tennessee