Veterinary Dermatology 2005, 16, 395 400

Case report

Blackwell Publishing, Ltd.

Pustular calicivirus dermatitis on the abdomen of

two cats following routine ovariectomy
J. DECLERCQ
Department of Small Animal Medicine and Clinical Biology, Faculty of Veterinary Medicine, Ghent University,
Salisburylaan 133, B-9820 Merelbeke, Belgium
(Received 11 June 2005; accepted 19 August 2005)

Abstract An unusual form of calicivirus dermatitis is described in two cats. Two fully vaccinated cats were readmitted for anorexia and depression following routine ovariectomy. Signs of upper respiratory disease were not
present. One cat subsequently showed painful necrosis of the incision wound, the other one developed dyspnoea
with pleural effusion and discrete tongue ulcers. Intact pustular lesions confined to the surgically prepared abdomen
appeared in both cats, respectively, on days 11 and 9. The histopathological diagnosis was panepidermal pustulosis
and necrotizing dermatitis. Positive immunohistochemical staining consistent with feline calicivirus antigen was
detected in epithelial cells within pustular lesions. The cats were treated with antibiotics and ketoprofen. The cat
with progressive dyspnoea was euthanized. The clinical signs in the other cat rapidly and completely resolved
following glucocorticoid therapy. It is hypothesized that the reported cases may represent a distinct calicivirusinduced pustular dermatitis following ovariectomy.

IN TRO D U CT ION
Feline calicivirus (FCV) is a common pathogen of cats,
which is typically associated with upper respiratory
disease and mild conjunctivitis.1,2 Infection can occur by
both direct cat to cat contact and indirect transmission
(on attendants hands).3 The initial site of infection is
thought to be the oropharynx. Vesicles and erosions on
tongue and/or palate are frequent and characteristic
features in experimentally infected cats.4 Multiple strains
of FCV exist and vaccination is not protective against
all strains.1,4,10,22 Strains greatly differ in their pathogenicity. A spectrum of diseases (from subclinical to
severe) and in tissue tropisms exists. A variety of clinical
manifestations, including bronchopneumonia,1,2 transient
febrile limping syndrome,58 virulent systemic infection913
and agitated state14 have been described.
There is sparse evidence in the literature that FCV
plays an important role as a pathogen in feline skin
disease. FCV is known to occasionally cause ulceration
on the nasal philtrum, lip and rarely elsewhere on the
body.13 Recovery of FCV from ulcerative skin lesions
in a young cat has been reported as paw and mouth
disease.15 Painful ulcers were present on the tongue,
palate, lips and feet. In recently reported outbreaks of
virulent systemic calicivirus infection,913 in addition
to internal signs, significant skin lesions have been
Correspondence: J Declercq, Department of Small Animal Medicine
and Clinical Biology, Faculty of Veterinary Medicine, Ghent University,
Salisburylaan 133, B-9820 Merelbeke, Belgium. Tel.: 003256214403;
Fax: 003256214348; E-mail: jan.declercq.vet@skynet.be
2005 European Society of Veterinary Dermatology

described. They included oral ulcerations, subcutaneous

oedema on the head and limbs, crusting and ulceration
on the nose, lips, pinnae, periocularly, and on the distal
limbs. Additionally, in some cases focal alopecia or
pustules may be noted.
The aim of the present paper is to describe unusual
pustular lesions on the abdomen of two cats following
routine ovariectomy on different occasions and caused
by calicivirus infection.

C A SE R E P O RT S
Case 1
A 7-month-old female Domestic Shorthair cat was
admitted for routine ovariectomy. The cat came from a
single cat household and had been vaccinated at
7 weeks and at 15 weeks against feline enteritis, feline
herpesvirus and feline calicivirus. Prior to surgery,
surgical instruments had been sterilized in an autoclave.
Ventral abdomen was clipped and aseptically prepared
with diluted chlorhexidine, ether and alcohol. No skin
lesions were noted at the time of surgery. Two days postoperatively (day 2), the cat was represented with
complaint of poor appetite, lethargy and pain. On physical
examination, a painful and swollen incision wound was
the main clinical finding. The rectal temperature was
38.8 C. The cat was treated with daily subcutaneous
injections of amoxicillin-clavulanate 8.75 mg kg1
(Synulox Ready-To-Use, Pfizer Animal Health, Italy) and
ketoprofen 2 mg kg1 (Ketofen, Merial, Lyon, France).
Over the next few days, the incision wound became
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J Declercq

Figure 1. Abdomen of cat, case 1. Photograph taken on day 11.

Note erythema, necrosis of the laparotomy incision wound with
numerous pustules at its distal end.

Figure 3. Abdomen of cat, case 1. Photograph taken on day 19.

Healing of the incision wound and resolution of erythema and
pustular lesions can be seen.

Figure 2. Detail abdomen of cat, case 1, showing the distal end of

the laparotomy incision wound and intact pustular lesions.
Figure 4. Low-power microscopic appearance of pustular lesions,
case 1. Epidermal pustulosis and necrotizing dermatitis. H&E, 40.

necrotic. As the cat continued to act painful and anorexic, it was decided on day 6 to perform a laparotomy.
Exploration of the abdomen revealed extensive necrosis
of falciform fat and multifocal omental fat necrosis.
Diseased fat tissue was removed, the incision wound
was debrided, and another type of suture material was
used for wound closure. The cat was discharged the
next day and amoxicillin-clavulanate treatment was
continued. It was readmitted 5 days later (day 11), still
suffering from anorexia and pain. At re-examination,
important skin lesions were noted. Erythema on the
clipped abdomen, especially along the incision, was
evident. Incision wound appeared necrotic (Fig. 1); and
numerous small, whitish, intact pustular lesions were
observed at its distal end (Fig. 2). Aspiration cytology
of pustule content revealed degenerate neutrophils.
Microbes and acantholytic cells were not observed on
cytology. Skin biopsies of pustular lesions were collected.
Because of failure of previous antibiotic treatment
and while awaiting histological findings, the cat was
administered prednisolone 2 mg kg1 once daily for
2 days (days 11 and 12). A significant improvement was
observed in the cats attitude and appetite within 48 h,
and the prednisolone dose was subsequently reduced to
1 mg kg1 once daily. On day 17, a marked resolution
of the pustular lesions (Fig. 3) was noted. On day 25,

the cat had fully recovered from the skin condition and
the incision wound had healed. Prednisolone therapy
was stopped. There has been no recurrence of lesions
for 1.5 years. Histopathology of skin lesions revealed
multiple intact pustules at all epidermal levels containing
mainly degenerate neutrophils and epithelial remnants.
The underlying dermis was diffusely infiltrated by mixed
inflammatory cells. The histopathological diagnosis was
panepidermal pustulosis and necrotizing dermatitis
(Fig. 4). Immunohistochemical staining by immunoperoxidase method (Prairie Diagnostic Services, Saskatoon,
Canada) was positive for calicivirus antigen (Fig. 5) and
negative for feline herpesvirus.

Case 2
An 8-month-old female Domestic Shorthair cat,
vaccinated at 10 weeks and at 18 weeks against feline
enteritis, feline herpesvirus and feline calicivirus, and
coming from a single cat household, was presented for
routine ovariectomy and had been surgically prepared
as in case 1. Three days later (day 3), the cat was readmitted, suffering from anorexia and profound
depression. Rectal temperature was 39.2 C. The cat was
hospitalized and treatment was started with Hartmanns

2005 European Society of Veterinary Dermatology, Veterinary Dermatology, 16, 395 400

Pustular Calicivirus dermatitis

Figure 5. Skin of cat, case 1. Photomicrograph of pustule contents.

Strong immunoreactivity of individual and sheets of epithelial cells
in a pustular lesion. Immunohistochemical staining for feline calici,
avidin biotin peroxidase complex method, 400.

397

Figure 7. Close up abdomen of cat, case 2. Photograph taken on day

9. Erythematous abdomen with large flaccid pustules.

Figure 8. Low-power microscopic appearance of pustular lesions,

case 2. Note florid panepidermal pustulosis. H&E, 40.

Figure 6. Tongue of cat, case 2. Discrete ulcers on the tip of the

tongue on day 7.

solution (sodium chloride, potassium chloride, calcium

chloride, sodium lactate) intravenously; and with
enrofloxacin 5 mg kg1 (Baytril, Bayer Animal Health,
Leverkusen, Germany), clavulanate-potentiated amoxicillin 8.75 mg kg1 and ketoprofen 2 mg kg1, all subcutaneously once daily. No improvement was observed
with this therapy. Between days 5 and 7, increasing
respiratory difficulty was noted. On day 7, discrete ulcers
were observed at the tip of the tongue (Fig. 6) and
thoracic radiography revealed severe pleural effusion.
In the presence of oral ulcers, a presumptive diagnosis
of FCV infection was made. Furosemide (Dimazon,
Intervet, Germany) was added to the treatment regimen
and administered subcutaneously once daily at 2 mg kg1.
On day 9, flaccid yellow pustules from 0.5 cm up to 3 cm
in diameter, were observed on an erythematous abdomen
(Fig. 7). As the cats condition had continued to deteriorate over the past 9 days despite treatments, and it still
showed signs of severe dyspnoea, the owners opted to
have the cat euthanized on that same day. Dermatohistopathologic changes in postmortem lesional skin
specimens matched those of case 1 and the diagnosis was
panepidermal pustulosis (Fig. 8). In addition to pleural

effusion, necropsy revealed purulent pneumonia and

peripancreatic fat necrosis on microscopic examination.
Skin, lung, liver, spleen and pancreas were submitted to
the Prairie Diagnostic Services (Saskatoon, Canada)
for immunohistochemical detection of FCV antigens.
Positive staining was present in skin and lung sections.

D ISC U S S IO N
One unique feature of these reported cases of calicivirus
infection was cutaneous involvement in a localized
pattern with an appearance of pustular disease rather
than the classically described facial and pedal ulcerative
dermatitis resulting from epithelial necrosis (cytopathic
effects).2 Pustular eruption is rare in cats. Differential
diagnosis included pemphigus foliaceus (PF), bacterial
pyoderma (especially in immunosuppressed cats), necrotizing dermatitis caused by bacterial contamination of
surgical scrub solutions and pustular drug eruption.
Pemphigus foliaceus (PF) is the most described pustular
disease in cats.16 Pustules are transient in nature and are
rarely seen. Clinically, only crusting is usually noted on
physical examination. Lesions limited to the abdomen
have not been reported. In the reported cases, acantholysis
was not a feature. The clinical finding of a florid pustular
eruption with absence of crusting, as observed clinically

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J Declercq

and microscopically in these cats, was uncommon.

Staphylococcus aureus is the causative agent in the pathogenesis of feline pyoderma. As with dogs, cats should
be evaluated for an underlying disease and immunosuppression.17,18 In the reported cases bacteria could
not be demonstrated on cytology and biopsy. However,
bacterial culture to rule out with certainty bacterial
pyoderma was not performed in these cases. Immunodeficiency also could not be ruled out because testing
for feline immunodeficiency virus and feline leukaemia
virus was not performed because of owners financial
concerns. However, the development of skin lesions in the
face of pre-existing treatment with enrofloxacin and
amoxicillin-clavulanate, antibiotics known for their efficacy against coagulase-positive staphylococcal bacteria,
and the excellent response to short-term glucocorticosteroid administration in case 1 without recurrence of
skin lesions when therapy was discontinued, did not
support a diagnosis of superficial bacterial pyoderma.
Stomatitis and dermatitis of the shaved abdominal
spay site and incision caused by bacterial contaminated
chlorhexidine scrubs used prior to surgery has been
reported in a cat.19 Lesions appeared on the fifth day and
were characterized by multifocal areas of full thickness
necrosis. Both cats of the present report underwent
spaying at the same facility but were presented on
different occasions, respectively, on January 2004 and on
February 2005. The lack of a common exposure to a
source of infection and the late appearance of their skin
lesions was not supportive of a bacterial dermatitis
caused by contaminated chlorhexidine scrubs. The marked
improvement following treatment with systemic corticosteroids and discontinuation of the medications in
case 1 was suggestive of a drug eruption. Pustular drug
reaction, however, was considered unlikely because
of the localized asymmetric pattern in this patient.
Localized pustular drug reaction has not been reported
in cats. Erythema multiforme was not considered likely
because of the morphology of the skin lesions and the
lack of keratinocyte apoptosis.
Calicivirus dermatitis remained a possibility in our
cases. Depression and anorexia may be seen in cats
infected with FCV. Pustules have been noted in some
cases.10 Cutaneous erythema and omental fat necrosis
present in case 1, have been previously described.13
Ulceration on the tongue with concurrent signs of
respiratory disease, as seen in case 2, is also consistent
with FCV.3 Positive immunohistochemical staining
consistent with feline calicivirus antigen was detected
in sheets and single epithelial cells within pustular
lesions in both cases. Interpretation of positive findings
is a problem inherent to direct detection methods of
viruses, as the presence of the virus by itself cannot be
used to definitively establish a diagnosis of viral-related
disease. The detected virus may not be the cause of the
clinical disease.20 Regardless of the method used to detect
FCV infection, the results of testing always should be
interpreted in light of consistent clinical signs.10
The route of cutaneous infection in our cats can only
be speculated: haematogenous spread or transmission

from the oropharynx by the cats licking of incision.

Acutely ill and carrier cats (FCV persists in the
oropharynx of many infected cats), shed large amounts
of virus from their oral cavities.2,11 In our cats, the
distribution of pustular lesions was limited to the
surgical prepared abdomen with lesion appearance,
respectively, on days 11 and 9. This finding could be
suggestive of secondary infection from the cats licking
with virus present in its oropharyngeal secretions, and
gaining access to damaged epithelium from grooming.
Alternatively, the infection could have come from the
aseptical preparation. In case 1, where necrosis of
falciform and omental fat was seen early on, it is also
possible that the virus might have spread haematogenously. Unfortunately in that case, the resected necrotic
tissue from laparotomy was not submitted for histopathology or immunohistochemical evaluation. From the
history of these cases, it is also not known whether the
cats were harbouring the virus on entry to the clinic or
whether they were infected at the time of surgery.
The lack of clinical signs of upper respiratory disease
or conjunctivitis, common for FCV infection, is also
important. As both cats had been fully vaccinated and
initially presented with nonspecific clinical signs (anorexia, depression), a diagnosis of calicivirus infection
was not straightforward. Vaccines, however, do not
prevent infection or persistent shedding of FCV
(carrier state).10,21,22 The appearance of very discrete
tongue ulcers in cat 2 late in the disease process was
fairly suggestive and provides support for repeated oral
inspections in diseased cats of suspected viral cause.
The role and use of systemic glucocorticoids in viral
disease is controversial. Healing of prolonged oral
ulceration associated with caliciviral disease can be
promoted by corticosteroids.3 Cats with the febrile
haemorrhagic syndrome have been treated with glucocorticoids at immunosuppressive doses (1 mg kg1 every
12 h) without increasing mortality and with weak
evidence that they may have beneficial effects.10 In the
second reported case, clinical signs were progressive with
development of severe dyspnoea. The cats condition
deteriorated rapidly, despite antibiotic treatment. It is
reasonable to speculate that a short course of glucocorticoids might have improved the condition. In the first
cat, the condition did not improve until corticosteroid
treatment was given. Within 2 days and without other
treatments, this cat rapidly improved in overall status.
Resolution of all skin lesions was complete within
14 days. This finding may suggest a beneficial effect of
glucocorticoids in severe cases of FCV infection.
In summary, it is proposed that FCV infection may
present as a distinctive pustular disease, even in vaccinated
cats, and that, in these cases, the infection was an unusual
manifestation of the virus following ovariectomy.

R E FE R E N C E S
1. Gaskell R, Dawson S. Feline respiratory disease. In:
Greene CE. ed. Infectious Diseases of the Dog and

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Pustular Calicivirus dermatitis

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

Cat, 2nd Edn. Philadelphia: W.B. Saunders, 1998;

97106.
Hoover EA. Viral respiratory diseases and chlamydiosis.
In: Holzworth J. ed. Diseases of the Cat. Medicine and
Surgery, Vol. I. Philadelphia: W.B. Saunders, 1987; 22230.
Povey RC, Jarrett JO. Viral diseases and diseases associated
with feline leukaemia virus infection. In: Wilkinson GT.
ed. Diseases of the Cat and Their Management, 2nd edn.
Oxford: Blackwell Scientific Publications, 1984; 398 401.
Pedersen NC. Feline calicivirus. In: Appel MJ. ed. Viral
Infections of Carnivores. Amsterdam: Elsevier Science
Publishers, 1987; 339 46.
Pedersen NC, LaLiberte L, Ekman S. A transient febrile
limping syndrome of kittens caused by two different
strains of feline calicivirus. Feline Practice 1983; 13: 635.
Bennett D, Gaskell RM, Mills A et al. Detection of feline
calicivirus antigens in the joints of infected cats. The
Veterinary Record 1989; 124: 32932.
Levy JK, Marsh A. Isolation of calicivirus from the joint
of a kitten with arthritis. Journal of the American
Veterinary Medical Association 1992; 201: 7535.
Dawson S, Bennett D, Carter SD et al. Acute arthritis of
cats associated with calicivirus infection. Research in
Veterinary Science 1994; 56: 133 43.
Pedersen NC, Elliott JB, Glasgow A et al. An isolated
epizootic of hemorrhagic-like fever in cats caused by
a novel and highly virulent strain of feline calicivirus.
Veterinary Microbiology 2000; 73: 281300.
Hurley KF, Sykes JE. Update on feline calicivirus:
new trends. Veterinary Clinics of North America Small
Animal Practice Emerging and Re-emerging Infectious
Diseases 2003; 33: 759 72.
Schorr-Evans EM, Poland A, Johnson WE et al. An
epizootic of highly virulent feline calicivirus disease in
a hospital setting in New England. Journal of Feline
Medicine and Surgery 2003; 5: 21726.

399

12. Hurley KF, Pesavento PA, Pedersen NC et al. An outbreak of virulent systemic feline calicivirus disease.
Journal of the American Veterinary Medical Association
2004; 224: 2419.
13. Pesavento PA, MacLachlan NJ, Dillard-Telm L et al.
Pathologic, immunohistochemical, and electron microscopic findings in naturally occurring virulent systemic
feline calicivirus infection in cats. Veterinary Pathology
2004; 41: 25763.
14. Sato Y, Ohe K, Fukuyama M et al. Properties of a
calicivirus isolated from cats dying in an agitated state.
The Veterinary Record 2004; 25: 8005.
15. Cooper LM, Sabine M. Paw and mouth disease in a cat.
Australian Veterinary Journal 1972; 48: 644.
16. Preziosi DE, Goldschmidt MH, Greek JS et al. Feline
pemphigus foliaceus: a retrospective analysis of 57 cases.
Veterinary Dermatology 2003; 14: 31321.
17. White SD. Pyoderma in five cats. Journal of the American
Animal Hospital Association 1991; 27: 1416.
18. Medleau L, Rakich PM, Latimer KS et al. Superficial
pyoderma in the cat: diagnosing an uncommon disorder.
Veterinary Medicine 1991; 86: 80711.
19. Rosenkrantz WS. Pseudomonas aeruginosa necrotizing
dermatitis, vasculitis and panniculitis in the cat. Proceedings of the 14th Annual Members Meeting AAVD &
ACVD, San Antonio, Texas 1998; 7778.
20. Yeary TJ, Kapil S. A primer on diagnostic virology:
direct and molecular-based detection of viral pathogens.
Compendium Continuing Education September 2004;
26(9): 7309.
21. Harbour DA, Howard PE, Gaskell RM. Isolation of
feline calicivirus and feline herpesvirus from domestic
cats 1980 to 1989. Veterinary Record 1991; 128: 7780.
22. Radford AD. Feline calicivirus a promising future.
Scientific Proceedings BSAVA Congress, Birmingham,
UK 2002; 2278.

Rsum Une forme inhabituelle de dermatite calicivirus est rapporte chez deux chats. Ces deux animaux, correctement vaccins, ont consult pour une anorexie et une baise de ltat gnral la suite dune ovariectomie de
routine. Aucun signe datteinte respiratoire na t not. Un chat a par la suite prsent une ncrose douloureuse
de la zone dincision chirurgicale, et un autre a dvelopp une dyspne avec une effusion pleurale et des ulcres
de la langue. Des lsions pustuleuses intactes localises sur la zone tondue de la chirurgie sont apparues chez
les deux chats, aux jours 11 et 9 respectivement. Le diagnostic histopathologique tait celui dune pustulose
ncrosante panpidermique. Un marquage immunohistochimique positif avec un antigne de calicivirus flin a
t observ. Les chats ont t traits avec des antibiotiques et du ktoprofne. Le chat dyspnique a d tre euthanasi. Les signes cliniques ont disparu chez lautre chat aprs un traitement corticode. Ces cas pourraient
reprsenter une forme particulire de calicivirose cutane pustuleuse, conscutive lovariectomie.
Resumen Se describe a continuacin una forma poco usual de dermatitis producida por calivirus en dos gatos.
Dos gatos con completa historia de vacunacin fueron admitidos con signos clnicos de anorexia y depresin tras
sufrir una operacin rutinaria de ovariectomia. No se observaron signos de enfermedad del tracto respiratorio
superior en ninguno de los dos gatos. Poco despus, uno de los gatos desarroll necrosis en la incisin quirrgica,
acompaada de dolor, mientras el segundo desarrollo disnea con efusin pleural y lceras linguales bien demarcadas. Asmismo, en ambos gatos aparecieron lesiones pustulares intactas restringidas a la zona de preparacin
del abdomen, en los das 11 y 9, respectivamente. El diagnstico histopatolgico fue de pustulosis panepidrmica
y dermatitis necrotizante. Mediante inmunohistoqumica observamos clulas epiteliales positivas para el antgeno de calicivirus felino en las lesiones pustulares. Los gatos se trataron con antibiticos y ketoprofeno. El gato
con disnea progresiva fue finalmente eutanasiado. Los signos clnicos en el segundo gato resolvieron rpidamente
tras el tratamiento con glucocorticoides. Nuestra hiptesis es que los casos presentados podran pertenecer a una
nueva variante de dermatitis pustular inducida por calicivirus tras ovariectomia.
Zusammenfassung Eine ungewhnliche Form von Calicivirus Dermatitis wird bei zwei Katzen beschrieben.
Zwei vollstndig geimpfte Katzen wurden nach routinemig durchgefhrter Ovarektomie wegen Anorexie und
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J Declercq
Schwche erneut vorgestellt. Anzeichen fr eine Erkrankung des oberen Respirationstrakts waren nicht
vorhanden. Bei einer Katze wurde in der Folge eine schmerzhafte Nekrose der Operationswunde festgestellt, die
andere entwickelte Dyspnoe mit Pleuralerguss und vereinzelten Zungengeschwren. Bei beiden Katzen entstanden am 11. bzw. am 9. Tag intakte Pusteln, die sich auf das fr den chirurgischen Eingriff vorbereitete Abdomen beschrnkten. Die histo-pathologische Diagnose lautete panepidermale Pustulosis und nekrotisierende
Dermatitis. Eine positive immunhistochemische Frbung, die mit dem felinen Calicivirus Antigen bereinstimmte, wurde in den Epithelzellen der Pusteln gefunden. Die Katzen wurden mit Antibiotika und Ketoprofen
behandelt. Die Katze mit progressiver Dyspnoe wurde euthanasiert. Bei der anderen Katze verschwanden die
klinischen Symptome in der Folge einer Behandlung mit Glukokortikoiden rasch und vollstndig. Es wird hypothetisiert, dass die beschriebenen Flle einer eigenstndigen Calicivirus-induzierten pustulsen Dermatitis nach
Ovarektomie entsprechen.

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2005 European Society of Veterinary Dermatology, Veterinary Dermatology, 16, 395 400