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When Charlie's owners came to see me it was always likely
he was going to be a difficult case as he had been unsuccessfully
treated elsewhere. I was however somewhat taken aback when
his owners suggested that the reason why he had such a hideously
ulcerated looking nose was because of a condition known
as "discoid lupus erythematosis". "Why is
it?", I thought to myself, "that when ever owners
self diagnose their own pets they always plump for the most
rare and bizarre conditions....................bleeding
Google!"
For 5 years at the University of Glasgow we were taught,
"Common conditions are often seen." There is no
doubt that over the last 25 years that mantra has held good
and the logical step by step process which we adopt at Fairfield
has held us in good stead for the diagnosis of many difficult
conditions through the process of ruling out the most likely
first. Consequently, in repsonse to their suggestion I proferred
the more commonly seen disease of "nasal pyoderma".
A 2 week course of appropriate antibiotics at the correct
dosage, needless to say, yielded no improvement. The next
logical step was a biopsy of "Charlie's" nose;
not a procedure to be taken lightly or indeed "sneezed
at."
Fortunately, "Charlie" and his owners took everything
in their stride including the final diagnosis of "discoid
lupus erythematosis" a RARE disease where in fact the
immune system (possibly aggravated by ultraviolet light)
decides to "attack" the nose causing quite severe
ulceration and consequent damage. In this instance, this
disease was very responsive to low doses of immunosuppressive
drugs and "Charlie's" good looks have now returned.
I have now updated our mantra, "Common conditions
occur commonly...............but that doesn't mean that
rare conditions don't crop up now and again!"
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