경화성 장간막염은 장간막에 만성 염증과 섬유화를 보이는 드문 질환으로 비교적 양호한 경과를 가지는 질환이다. 복부 컴퓨터단층촬영을 포함한 특징적 영상소견이 진단에 도움이 된다. 그러나 경화성 장간막염은 몇몇 악성 질환들과 유사한 형태를 보일 수 있으며, 이들은 치료방법 및 경과 자체가 완전히 다르기 때문에 악성 질환에 대한 적극적 배제가 중요하다. 저자들은 체중 감소 및 지속되는 설사 증상으로 내원한 75세 남성 환자가 복부 컴퓨터단층촬영상 장간막 혈 관 주변 연무양 감쇄의 특징적 소견을 보여 경화성 장간막염 으로 오인하였으나, 추적관찰 및 추가적으로 시행한 조직검 사와 양성자방출 컴퓨터단층촬영술을 통하여 최종적으로 총담관암과 그에 동반된 림프절전이로 진단하였던 드문 증 례를 경험하여 이를 보고하고자 한다.

This report describes the different responses to dapsone treatment in two cases of sterile nodular panniculitis (SNP). Two dogs were presented with ulcerative skin lesions, painful and erythematous papules, and nodules. History and physical examination revealed systemic signs such as pyrexia, lethargy, depression, and anorexia, in addition to ulcerated and ruptured nodules on the skin. The dermatological diagnostics included clear taping, trichogram, skin scraping, impression smears, fungal and bacterial cultures, and histopathology and special stainings of multiple punch biopsies obtained from the skin lesions. Based on the clinical and histopathologic findings, the absence of microbiological infection, and the positive response to immunosuppressive therapy, both the dogs were diagnosed with SNP. Although both dogs had been treated with various immunosuppressive drugs including prednisolone, cyclosporine, azathioprine, and triamcinolone, therapy was switched to dapsone due to recurrent dermatological signs and presumed steroidinduced hepatotoxicity. The clinical responses to dapsone were opposite in the two cases. In the first case, combination therapy with prednisolone and cyclosporine was effective in attenuating ulcerative lesions, while dapsone alone did not control the clinical signs. In contrast, in the second case, the therapeutic response to the common immunomodulatory drugs such as prednisolone, triamcinolone, and azathioprine was inadequate. Interestingly, dapsone alone was effective in controlling the clinical signs without causing undue side effects. Although the usefulness of dapsone for the treatment of canine SNP is unknown, it may be considered in mild to moderate cases of SNP when the use of steroids is not recommended due to its low efficacy or side effects.