Eosinophilic Stomatitis and the
Cavalier King Charles Spaniel
Cavalier King Charles spaniels are predisposed to some eosinophilic syndromes, especially eosinophilic stomatitis, an autoimmune disorder.
What It Is
Stomatitis is an inflammation of the mucous lining of any parts of the mouth, such as the tongue, palate, and gums. It usually appears as ulcers and lesions on the surfaces within the mouth.
Eosinophils, short for eosinophil granulocytes, are white blood cells which are a component of the immune system. These cells normally are found in parts of the brain, gastrointestinal tract, and some lower body organs and serve to combat certain parasites and infections. When eosinophils are activated by an immune stimulus, they release cell-killing proteins capable of damaging tissues, ideally those of the parasites and infecting pathogen. When they infiltrate and accumulate in the lungs, esophagus, or respiratory tract, they are associated with an immune dysfunction and may damage the dog’s own tissues.
Other forms of eosinophilic syndromes found in Cavaliers are eosinophilic bronchopneumonopathy (airway disease) and eosinophilic enteritis (intestinal).
Symptoms
The common symptoms are ulcers – which appear as appear as inflamed
crater-like sores – on the surfaces of the mouth, such as the gums and soft
palate (see photo at right). Lesions – such as bumps or blisters – also may be present
(see photo below).
The inflamed areas will be sensitive and painful, so the dog may exhibit difficulty in eating or a loss of appetite. Other clinical signs include halitosis, swallowing problems, coughing during meals, or clearing the throat. Often, the dog shows no visible symptoms, and the disorder is not discovered unless the dog's mouth is examined.
Diagnosis
The appearance of the sores could be due to any of several causes. Thorough visual examination and a biopsy are standard procedure. A complete blood count, viral panel, and chemistry panel likely will be performed. Blood panel results usually are normal, except for elevated immunoglobulins reflecting chronic stimulation. Radiographs of the jaw may also be taken. The dog may be placed under anesthesia for some of these procedures.
Treatment
Since eosinophilic stomatitis is the result of an inappropriate, exceptionally active immune response, treatment usually includes immunosuppressive doses of corticosteriods and/or other immune-suppressing drugs. They include prednisolone, azathioprine (Imuran, Azasan), cyclosporine (Sandimmune, Neoral, Cicloral, Gengraf), and glucocorticoid (cortisol).
Non-steroidal anti-inflammatory agents (NSAIDs) may provide both pain killing and anti-inflammatory relief.
Antibiotics, especially clavamox and clindamycin, but also metronidazole, doxycycline, and azithromycin, may also be prescribed to offset any bacterial infection due to the side effects of the immune suppressing drugs.
Tooth removal may also be necessary.
Veterinary Resources
Ulcerative eosinophilic stomatitis in three
Cavalier King Charles spaniels.
Joffe DJ, Allen AL. J Am Anim Hosp Assoc 1995 Jan-Feb; 31(1):34-7. Quote:
"Ulcerative eosinophilic
stomatitis affecting three Cavalier King
Charles spaniels is described. The lesions are similar in gross
appearance to previously reported palatine eosinophilic granulomas, but
histologically they lack granuloma formation. The cause of the lesions is not
known. Treatment with corticosteroids led to the resolution of one case and
partial resolution of a second. A third case resolved spontaneously without
therapy."
Oral eosinophilic granuloma in three cavalier King Charles spaniels. Bredal WP, Gunnes G, Vollset I, Ulstein TL. J Small Anim Pract. 1996 Oct;37(10):499-504. Quote: "Oral eosinophilic granuloma is a rare and enigmatic disease in dogs. The clinical, haematological, cytological and histopathological features of three unrelated Cavalier King Charles spaniels with oral ulcers are presented. The disease was characterised by granuloma or plaque formation in the oral cavity. Common clinical signs were clearing the throat, swallowing problems, coughing during and after meals, reduced appetite and difficulty in eating. Haematological findings were not specific. Cytology was considered easier to perform than tissue biopsy due to friability of the tissue, but could not be used to confirm a granuloma diagnosis. The diagnosis of oral eosinophilic granuloma was verified histopathologically in each case. Response to glucocorticoid therapy varied, from complete remission to lack of any visible effect, leading to a guarded prognosis. The aetiology of the disease was not determined; however, the gross and microscopic morphologies of the lesions, their location and the response to corticosteroid therapy was suggestive of hypersensitivity.
Eosinophilic diseases in two Cavalier King Charles spaniels. A. J. German11, D. J. Holden1, E. J. Hall1 and M. J. Day. J Small Anim Pract. 2002 Dec;43(12):533-8. Quote: "This report describes the clinical presentation of two Cavalier King Charles spaniels with different eosinophilic diseases. The first case presented with dyspnoea and a non-productive cough, and investigations demonstrated eosinophilic bronchopneumonopathy. The second dog was referred for the investigation of haemorrhagic vomiting and diarrhoea and was eventually diagnosed with eosinophilic enteritis. Both dogs had concurrent eosinophilic stomatitis, and both responded completely to immunosuppressive glucocorticoid therapy. This report is the first to describe the concurrence of eosinophilic stomatitis and systemic eosinophilic disease in Cavalier King Charles spaniels, and suggest that this breed may be predisposed to eosinophilic syndromes."
Eosinophilic Diseases of Dogs. Caroline Mansfield. 2008 WSAVA Congress. www.vin.com/proceedings/Proceedings.plx?CID=WSAVA2008&PID=pr23852&O=Generic Quote: "Cavalier King Charles spaniels, Alaskan malamutes and Siberian huskies appear predisposed to eosinophilic stomatitis, intestinal and airway disease."
