CLINICAL REPORT https://doi.org/10.21708/avb.2023.17.

311848

First case of cutaneous mycobacteriosis in a

domestic feline in southern Brazil
Primeiro caso de micobacteriose cutânea em um felino doméstico no sul do Brasil
Paula Michelson Vanzin1* , Ezequiel Davi dos Santos1 , Aline Bielak dos Santos1 ,
Rúbia Schallenberger da Silva2 , Bibiana da Rosa Pereira1 , Adriana Costa da Motta1

ABSTRACT: Tegumentary mycobacteriosis in cats is not very common. Three manifestations of skin disease associated with
mycobacteria are recognized in domestic cats: feline leprosy, cutaneous tuberculosis and atypical mycobacteriosis. This study
aims to describe a case of feline pyogranulomatous panniculitis associated with Mycobacterium spp., diagnosed through
histopathology and histochemistry. The case occurred in a domestic feline, three years old, five kg, male, of mixed breed,
which, in the clinical-physical exam, presented multiple subcutaneous nodules without ulceration of the epidermis and of
firm-elastic consistency in the axillary and pectoral regions. One of the axillary nodules was surgically removed, placed in
10% formalin and sent for anatomopathological examination. Histologically, severe, sometimes multifocal, marked focally
extensive pyogranulomatous dermatitis and panniculitis were revealed. Amid pyogranulomatous panniculitis, there was the
formation of extracellular lipid vacuoles, also called lipocysts, surrounded by numerous neutrophils and histiocytes and with
a lumen displaying eosinophilic amorphous material with a granular appearance. Histological sections were submitted to
special Ziehl-Neelsen staining to detect alcohol-acid-resistant bacillus (BAAR), revealing multiple extra and intra-histiocytic
mycobacteria inside the lipocysts. Thus, the anatomopathological and histochemical findings found in the feline indicated
that this was the first case of pyogranulomatous dermatitis and panniculitis associated with Mycobacterium spp. reported in
southern Brazil.

KEYWORDS: Atypical mycobacteria; Panniculitis; Dermatitis; Cats.

RESUMO: As micobacterioses tegumentares em gatos não são comuns. Em felinos domésticos são reconhecidas três
manifestações de doença de pele associada a micobactérias, sendo a hanseníase felina, a tuberculose cutânea e a micobacteriose
atípica. Este estudo objetiva descrever um caso de paniculite piogranulomatosa em felino associada a Mycobacterium spp.
diagnosticado através de histopatologia e histoquímica. O caso ocorreu em um felino doméstico, três anos, cinco kg, macho,
sem raça definida, e que no exame clínico-físico apresentava múltiplos nódulos subcutâneos, sem ulceração da epiderme, e
de consistência firme-elástica em região axilar e peitoral. Um dos nódulos axilares foi removido cirurgicamente, alocado em
formalina 10% e enviado para exame anatomopatológico. Histologicamente foi revelada marcada dermatite e paniculite
piogranulomatosas focalmente extensiva acentuada, por vezes multifocal. Em meio a paniculite piogranulomatosas havia
formação de vacúolos lipídicos extracelulares, também chamados de lipocistos, circundados por numerosos neutrófilos e
histiócitos, e com lúmen exibindo material amorfo eosinofílico de aspecto granular. Cortes histológicos foram submetidos a
coloração especial de Ziehl-Neelsen para pesquisa de bacilos álcool-ácido resistentes (BAAR), revelando múltiplas micobactérias
extra e intra-histiocíticas e no interior dos lipocistos. Assim, os achados anatomopatológicos e histoquímicos encontrados no
felino indicaram tratar-se do primeiro caso de dermatite e paniculite piogranulomatosas associadas a Mycobacterium spp.
relatado no Sul do Brasil.

PALAVRAS-CHAVE: Micobactéria atípica; Paniculite; Dermatite; Gatos.

1
Universidade de Passo Fundo, Passo Fundo/RS, Brasil
2
Universidade Federal de Santa Maria, Santa Maria/RS, Brasil
*Corresponding author: [email protected]
Received: 03/17/2023 Accepted: 08/22/2023

16 Acta Veterinaria Brasilica September 17 (2023) 16-19

 First case of cutaneous mycobacteriosis in a domestic feline in southern Brazil

INTRODUCTION numerous macrophages, epithelioid macrophages and neu-

Tegumentary mycobacterioses are uncommon in the clini- trophils, sparse lymphocytes and plasma cells, rare mast cells
cal routine of domestic cats. However, several species of the and eosinophils, and occasional Langhans-type giant cells.
genus Mycobacterium can affect the dermis and subcutaneous There were also reactive fibroblasts and granulation tissue sur-
tissue of cats, including tuberculous mycobacteria (M. Bovis rounding the foci of inflammation and distributed among the
and M. tuberculosis), mycobacteria that cause leprosy (M. lep- adipocytes of the adipose tissue with inflammation. In some
raemurium) and atypical mycobacteria (White et al., 1983 ; areas, mild multifocal hemorrhage, fibrin deposition, cellular
Davies et al., 2006). Atypical mycobacterioses are considered debris, and mild edema were observed. Amid pyogranulo-
opportunistic or facultative and are commonly found in soil, matous panniculitis, there was the formation of extracellular
water and decaying vegetation. Infections by these agents usu- lipid vacuoles (lipocysts) surrounded by numerous neutro-
ally occur due to wound contamination or traumatic implan- phils and histiocytes, with the lumen showing amorphous
tation (Malik et al., 2000; Youssef et al., 2002). eosinophilic material with a granular to filamentary appear-
Furthermore, these mycobacteria have a predilection ance (Figure 2A).
for tissues rich in lipids, and in domestic cats, lesions occur Tissue sections were submitted to special Ziehl-Neelsen
mainly in the subcutaneous tissue of the ventral abdomen staining to detect alcohol-acid-resistant bacillus (AFB). In the
and inguinal region, causing pyogranulomatous panniculi- analysis, the samples showed a positive colorimetric/histochem-
tis (Vshkautsan et al., 2016; De Sousa et al., 2021). Animal- ical reaction for sparse BAAR-compatible bacterial structures
to-animal transmission is not reported, moreover, atypical extra and intra-histiocytic and inside the lipocysts (Figure 2B).
mycobacteria are not considered zoonotic (Pekkarinen et al., Tissue sections were also submitted to special Grocott stain-
2018; Apostolopoulos et al., 2021). The present study aims ing and special Periodic Acid Schiff (PAS) staining to verify
to report the first pyogranulomatous dermatitis and pannicu- fungal structures, which were not evidenced. Thus, the anato-
litis in a domestic feline associated with Mycobacterium spp. mopathological and histochemical findings indicated that this
in southern Brazil. was a feline pyogranulomatous panniculitis associated with
Mycobacterium spp.
CASE REPORT
A cutaneous biopsy of a feline, 3 years old, 5 kg, male, mixed DISCUSSION
breed, was referred for anatomopathological examination. The feline in the report lived in an urban environment with
The lesion consisted of an irregular fragment of white-brown, sporadic access to the street, an epidemiologically favorable
rough and hairy skin, referred to as the axillary region of the condition for infection through the traumatic implantation
right thoracic limb, measuring 2.5x1.7x1.5 cm (Figure 1A). of atypical mycobacteria, especially in cases of animal interac-
When cut, the subcutaneous tissue showed a poorly delimited tion. After all, atypical mycobacteria are considered opportu-
area of brownish-yellow color and soft consistency, measuring nistic pathogens or facultative pathogens and are commonly
1.2x1 cm (Figure 1B). found in soil, water and decaying vegetation, such as the
On histopathological examination, the deep dermis and species M. fortuitum, M. phlei, M. smegmatis, M. chelonae,
adipose tissue showed accentuated focally extensive pyogranu- M. abscessus, M. flavescens, M. thermoresistibile and M. xenopi
lomatous dermatitis and panniculitis, sometimes multifocal. (White et al., 1983; Malik et al., 2000; Youssef et al., 2002;
The pyogranulomatous inflammatory infiltrate comprised Davies et al., 2006).


Authors, 2023.
Figure 1. Cutaneous mycobacteriosis in a feline. A) Irregular skin fragment sent for anatomopathological examination. B) Cutaneous
fragment showing subcutaneous tissue with an ill-defined area, yellow-brown in color and soft in consistency.

Acta Veterinaria Brasilica September 17 (2023) 16-19 17

 Vanzin et al.


Authors, 2023.
Figure 2. Cutaneous mycobacteriosis in a feline. A) Pyogranulomatous panniculitis with the formation of extracellular lipid vacuoles
(lipocysts) surrounded by histiocytes and neutrophils (arrows). HE, 100X. In detail, lipocyst with lumen showing eosinophilic amorphous
material with a granular to filamentary appearance. HE, 400X. B) Pyogranulomatous panniculitis with multiple reddish-pink extra and
intra-histiocytic mycobacteria inside the lipocysts. Ziehl-Neelsen, 1000X.

Atypical mycobacteria have a predilection for tissues rich microbial involvement (Davies et al., 2006; Gunn-Moore,
in lipids, causing pyogranulomatous panniculitis. In felines, the 2014). Regarding subcutaneous masses/nodules, the primary
lesions are observed mainly in the subcutaneous tissue of the diagnostic suspicion falls on soft tissue neoplasms, which
ventral abdomen and inguinal region and appear as multiple are relatively common in cats (Dobromylskyj et al., 2021).
nodules (Vishkautsan et al., 2016; De Sousa et al., 2021), as However, in the case of atypical cutaneous mycobacteriosis,
in the present case in which the subcutaneous nodules were the histopathological analysis rejects the hypothesis of neo-
detected in the feline axillary and pectoral region. The intro- plasia and indicates that it is a subcutaneous lesion of the
duction of atypical alcohol-acid-fast bacillus (BAAR) into the pyogranulomatous type (Miller et al., 1999). For this type of
adipose tissue facilitates their pathogenicity and rapid pro- lesion, the presence of fungi should be considered and inves-
liferation, as nutrients are abundant and the adipose tissue tigated using special Grocott and PAS staining and myco-
acts by protecting the AFB from the host’s immune response bacteria using special Ziehl-Neelsen staining (Davies et al.,
(White et al., 1983; Gunn-Moore, 2014; Pekkarinen et al., 2006). In the case of ulcerated and/or purulent lesions, it
2018; Apostolopoulos et al., 2021). Due to the predilection is also recommended to collect material or tissue fragments
for tissues rich in lipids, obesity with accumulation of sub- from deeper portions for cytological examinations, micro-
cutaneous adipose tissue is considered a risk factor for the biological culture (fungi and bacteria) or molecular analy-
development of mycobacterial panniculitis, especially in sis (Vishkautsan et al., 2016; Apostolopoulos et al., 2021).
domestic felines that have access to the street, as they have The use of PCR is of great value, as it allows the confirma-
a greater risk of suffering traumatic injuries (Davies et al., tion of the histological and histochemical diagnosis and the
2006; Gunn-Moore, 2014). identification of the mycobacterial species (Apostolopoulos
During the consultation, it was verified that the feline et al., 2021). In the reported case, the diagnosis was confirmed
in the report was clinically well and that the other feline that through histopathological and histochemical analysis, which
lived with it did not present any clinical and/or cutaneous/ revealed pyogranulomatous dermatitis and panniculitis asso-
subcutaneous alteration. Such findings corroborate the litera- ciated with Mycobacterium spp.
ture, which emphasizes that animal-to-animal transmission is
uncommon and that cats affected by atypical cutaneous myco- CONCLUSION
bacteriosis are generally not immunocompromised and/or Through anatomopathological and histochemical analysis,
exhibit comorbidities (Pekkarinen et al., 2018; Apostolopoulos it was elucidated that Mycobacterium spp. was the cause of
et al., 2021). Regarding age and gender predisposition, studies dermatitis and pyogranulomatous panniculitis in the feline in
point out that all affected cats were between 3 and 10 years question. The report warns of cutaneous mycobacteriosis in
old and were primarily females (Malik et al., 2000; Davies domestic cats in southern Brazil, this being the first reported
et al., 2006), while the feline reported this is a 3-year-old male. case. The study also highlights the need for further epidemi-
Suspicion and clinical diagnosis are not easy tasks, ological investigation of mycobacteriosis and understanding
especially when there are no superficial skin lesions, such as its pathogenesis in felines to develop strategies for early detec-
ulceration or alopecia, that would lead to the assumption of tion and safe treatment.

18 Acta Veterinaria Brasilica September 17 (2023) 16-19

 First case of cutaneous mycobacteriosis in a domestic feline in southern Brazil

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