Hepatocutaneous syndrome in a dog with concurrent Ehrlichiosis: Case report

This report describes the diagnosis of hepatocutaneous syndrome in a dog concurrently affected by Ehrlichiosis. A 13-year-old Golden Retriever presented with lethargy, fever, lymphadenopathy, and dermatological lesions on the paws, perianal region, and testes, characterized by hyperkeratosis, erosion, ulceration, crusting, and exudation. Clinicopathological evaluation revealed regenerative anemia, lymphopenia, monocytopenia, basophilia, thrombocytopenia, and increased serum activities of alkaline phosphatase, alanine transaminase, and gamma-glutamyl transferase. After ruling out other vector-borne diseases (e.g., Leishmaniasis, Anaplasmosis, Babesiosis), Ehrlichiosis was diagnosed. Abdominal ultrasonography revealed a honeycomb-like hepatic echotexture, and differential diagnoses for hepatocutaneous syndrome included pemphigus foliaceus/vulgaris, systemic lupus erythematosus, drug eruptions, and zinc-responsive dermatosis. Ultimately, the clinical, laboratory, and ultrasonographic findings supported concurrent diagnoses of hepatocutaneous syndrome and Ehrlichiosis. The dog died, most likely due to severe hepatic dysfunction and associated coagulopathy; disseminated intravascular coagulation was suspected based on the clinical course, although it could not be confirmed due to the absence of coagulation testing, despite receiving combination therapy that included vitamin–amino acid infusion, ursodeoxycholic acid, antioxidant nutraceuticals (S-adenosylmethionine, Silybum marianum, phospholipids, zinc), omega-3 fatty acids, and benzoyl peroxide shampoo for hepatocutaneous syndrome, in addition to doxycycline and prednisolone for ehrlichiosis. This case report highlights the diagnostic complexity of hepatocutaneous syndrome, particularly when concurrent with infectious diseases such as Ehrlichiosis. It demonstrates how overlapping clinical signs can complicate diagnosis and delay appropriate treatment. To the authors’ knowledge, this is the first documented case of hepatocutaneous syndrome in a dog concurrently diagnosed with Ehrlichiosis. By presenting this case, we aim to raise awareness among veterinary clinicians of the importance of a thorough diagnostic workup in dogs exhibiting compatible dermatologic and systemic signs, even in regions endemic for tick-borne diseases.