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Probable drug-triggered pemphigus foliaceus in a dog following administration of afoxolaner (NexGard)
  1. Amelia White1,
  2. Karly Hicks1,
  3. Petra Bizikova2,
  4. Jessica Bailey3 and
  5. Keith Linder2
  1. 1Department of Clinical Sciences, Auburn College of Veterinary Medicine, Auburn, Alabama, USA
  2. 2College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
  3. 3Department of Pathobiology, Auburn College of Veterinary Medicine, Auburn, Alabama, USA
  1. Correspondence to Dr Amelia White; agw0013{at}


A nine-year-old castrated male miniature dachshund presented for chronic pustular dermatitis, lethargy, fever and weight loss. There was no history of dermatological disease prior to lesion development which occurred within days following administration of afoxolaner (NexGard) and worsened with each of the five subsequent doses. Physical examination revealed multifocal alopecia, diffuse crusting and peripheral lymphadenomegaly. Multiple intact panfollicular pustules were present in the inguinal region, concave pinnae and ear canals. Cytology from intact pustules revealed non-degenerate neutrophils, acantholytic keratinocytes with no bacterial or fungal organisms. Deep skin scrape and dermatophyte culture were negative. Full-thickness cutaneous punch biopsy samples of intact pustules were obtained, and histopathological findings included subcorneal acantholytic pustular dermatosis. This was consistent with the clinical findings and the diagnosis of pemphigus foliaceus. Treatment was initiated with immunosuppressive prednisone and cyclosporine and remission was achieved. Medications were slowly tapered, though low doses were required to maintain long-term remission.

  • adverse drug reaction
  • drug allergy
  • dermatology
  • isoxazoline
  • canine
  • pemphigus foliaceus
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  • Contributors All authors listed have contributed significantly to the diagnosis and management of the case as well as manuscript preparation.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No additional data are available.

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