Eosinophilic Stomatitis, Granuloma and CUPS in a Cavalier King Charles Spaniel

Eosinophilic stomatitis and eosoniphilic granuloma are common names associated with raised ulcerative oral lesions in dogs mainly associated with the palate and occassionally the tongue.  The Cavalier King Charles Spaniel is particularly susceptable.  Antigenic stimulation is thought to be the cause however often specific etiology cannot be determined.  This Cavalier had both eosinophilic stomatitis and CUPS.  The CUPS appeared to be the painful component in this patient and is a consistent component of most if not all cases of CUPS.  Eliminating the plaque with strict home care including brushing daily, and water additives to reduce plaque (Healthy Mouth) along with frequent prophy’s in the hospital (generally every 3 months)  is the only safe treatment for CUPS.  Immunosuppressive therapy is an alternative but potentially dangerous approach to therapy.  Extracting the teeth adjacent to the lesions is the only definitive curative therapy.

Biopsy is indicated to confirm eosinophilic stomatitis.  Treatment involves corticosteroids or cyclosporin and some have advocated hypoallergenic foods.  Some patients do not respond to any of the above recommendations.   A determination must be made to assess patient pain.  Some of these patients appear not to be painful, however careful evaluation is needed to determine oral pain for this condition in dogs.  Palpation under light sedation may reveal jaw chattering.

Eosinophilic granuloma, stomatitis on the soft palate Cavalier King Charles Spaniel Dog

Eosinophilic Granuloma, Stomatitis in a Cavalier King Charles Spaniel Dog

CUPS in a Cavalier King Charles Spaniel Dog

CUPS in a Cavalier King Charles Spaniel Dog

CUPS in a Cavalier King Charles Spaniel Dog

CUPS in a Cavalier King Charles Spaniel Dog

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17 Responses to Eosinophilic Stomatitis, Granuloma and CUPS in a Cavalier King Charles Spaniel

  1. Sherry Ney says:

    I own a 5.5 yr old boxer who devlpd gingivitis hyperplasia (GH) appx 3 yrs ago.(I believe it was caused by drinking toilet water.Gingivectomy (GV) done at local vet & much imprvd.Once (GV) has been done, does it return with vengeance?(It has, & we can no longer see his bottom front teeth.)Is this disease spreadable to our 2 cats, other dogs, or humans?Can gingivitis be cured, as in humans?Or, will GV need to be done every 3 yrs until he passes?He NOW drinks from glass food/water dishes/ cleaned daily.

  2. Brett says:

    Hi Sherry.
    The gingival hyperplasia will recur and will need to be approached every 2-3 years generally. The key as you have seen with the post you commented on is dental xrays prior to the procedure to see what is going on under the gum. It does no good to excise the tissue adjacent to a tooth that has significant bone destruction from periodontal disease.
    Sincerely,
    Dr. Beckman

  3. Nice posting, thanks for sharing with us. It is more useful for me. Awesome post.

  4. Jacqui says:

    Hi Dr Beckman,

    I have a King Charles Cavalier Spaniel who has an ulcer in the back of his throat which looks very much like the first picture above of the eosinophilic granuloma stomatitis. He also has frequent lower jaw chattering which seems to occur mostly within the first 10 minutes after he wakes up. Our vet (I’m in Sydney, Australia) gave him a cortisone injection in early december last year and the chattering stopped completely, while the ulcer reduced in size (but did not completely disappear). The chattering has now started again (only two and a half months later). The vet has told me he has this autoimmune disease and has suggested further cortisone (every time it wears off) as well as a pill he likened to chemotherapy. I am not particularly comfortable with the long term use of all these drugs. Is cortisone long term every couple of months going to affect him? Additionally your post seems to suggest dental hygene is a big part of the solution – would it be sufficient treatment without the drugs? Or do they need to be used in conjunction? My vet has been low on the details so I would very much appreciate your advice. Many thanks in advance.

  5. Brett says:

    Hi Jacqui,
    Sorry to hear about you Cavalier. Steroids are a consistently predictable treatment. Ask you vet about prednisone orally and decrease to the lowest effective dose, preferably every other day. This is a frustrating condition but may be associated with stomatitis requiring tooth extraction. An oral exam under sedation, good lighting and magnification along with dental x-rays are needed to evaluate for this and underlying periodontal disease. Reducing the antigen load in the mouth with a hypoallergenic diet may or may not be of benefit.
    Brett

  6. Robyn Williams says:

    Hi, my male cavalier King charles spaniel was diagnosed over 19 months ago with Eosinophilic pharyngitis/ gingivtis, and has basically been on cortisone since. He was always sick as a puppy and I had noticed a sore at the back of his mouth To help with his weight gain the vet has placed charlie on Neoral. As we have discovered over the last year charlie smudge has had issues with his glands and his tonsils, but nothing really with his teeth. What is chattering?? I am not sure if my boy does it or not. When charlie was diagnosed, done with a biopsy,I seached on the internet for any info on this disorder, but it was all about cats. Charlie has Neoral every 2nd day and this seems to keep the disorder at bay most days.

  7. Brett says:

    Hi Robyn,
    Chattering suggests pain. If there is a plaque insensitive inflammation associated with this that may be the issue however if no dental radiographs have been taken this is paramount. A veterinary referral is in order.
    Brett

  8. Tracy Bowen says:

    Hello,

    I have a Cav with the same symptoms. What have you discovered to be the best treatment to keep the ulcers away?

    Thank you,
    Tracy

  9. Brett says:

    Hi Tracey,
    Please refer back to the post where the treatment is discussed.
    Brett

  10. Jody says:

    I have a 9 yr. old female cavalier who has had two tumors removed form her moucth in the last 5 mos. The first one’s biopsy came back as a polyp. The last one just came back as a eosinophilic granuloma. It had adhered to her tongue and down her throat. The vet is talking about putting her on steroids. Any other suggestions?

  11. Brett says:

    Hello Jody,
    That is the most effective, cyclosporin is an option however reread the post for a better description of the disease and treatment.
    Brett

  12. Bethany says:

    Our dog, Ruby, recently had a growth removed from her mouth that was since diagnosed as oral eosinophilic ‘granuloma’ syndrome. We understand this syndrome in prevalent in Cavalier King Charles Spaniels and are not thought to cause pain and should go away on their own.
    Since the growth has been removed and the incisions healed, 4 new growths have appeared in the same spot. She has not been prescribed any medicine or dietary changes.
    In your experience are these growths painless and go away without treatment?
    Ruby had also recently started chattering her teeth together at random times throughout the day and night, always when she is calm and warm.
    I look forward to your response.
    Thank you,
    Bethany

  13. Brett says:

    Hi Bethany,
    Some dogs show signs of pain and others we can touch the areas and they show no response. Tooth chattering is a sign of pain. Many of these patients have concurrent stomatitis or periodontal disease. If Ruby has not had full mouth dental radiographs this is the next step to rule out other disease. The lesion should also be evaluated for pain by palpation to determine if it is painful.
    Dr. B

  14. Robyn Williams says:

    Hi Brett, Charlie smudge was on cyclosporine for 18 months. Yes this cleared up his throat and mouth and kept the eosinophilic at bay. But unfortunately he kept getting cysts on his feet. So it wouldn’t cost me a fortune in vet fees, we tried him on emu oil and wearing shoes when out walking. If this didn’t help his feet they would have to have done a biopsy to work out the cause, which we believed was grass. So Charlie is off cyclosporine and back on cortisone, half a tablet every 2 to 3 days, the blue ones. His teeth are perfect, no tartar either, pretty good for a 4 year old cavalier with Eosinophilic.

  15. Kathryn says:

    Hi,
    I have an 8 year old female German Shepherd. She was diagnosed 2.5 years ago with eosinophilic stomatitis. The ulcer is at the interface between her hard and soft palette. It was discovered during a routine tooth cleaning. A punch biopsy was taken which determined a high prevalence of eosinophils. We left her untreated for 6 months at which time her teeth began to frequently chatter. We found that a daily dose of 2.5mg of Prednisone orally kept her visible symptoms (tooth chattering) at bay. We have also tried a hypoallergenic diet as well as Metacam (after detox from Prednisone), neither of which provided symptom relief. 2.5mgs/day is the lowest dose we can use to provide symptom relief.

    I am writing because she is now experiencing elevated ALT (liver enzyme) numbers (212 up from 38 last year). We are under the care of a veterinarian. We have follow-up bloodwork scheduled and will run a bioacids test if necessary as well. I am wondering if you have any other thoughts of treatments that could a)keep her out of pain from the eosinophilic stomatitis and b)give her liver some relief?

    Many thanks,
    Kathryn

  16. Brett says:

    Hi Kathryn,
    Although it is possible for eosinphilic granuloma (stomatitis) to cause chattering the location of the lesions makes this very unlikely. I would recommend that a veterinary dentist evaluate her whole oral cavity with full mouth radiographs to rule out more likely sources of discomfort. In the meantime gabapentin at 3-5 mg/kg BID and tramadol at a slightly decreased dose due to the enzyme changes can be given at 3 mg/kg TID pending your veterinarians acknowledgement. A topical antiiflamatory agent called TDC-1 comes in gel caps which can be opened and applied topically and has been shown to be effective against inflammation. Please keep us posted.
    Brett

  17. Tracy says:

    My Cav has the same thing… I’m trying Healthy Mouth in her water. So far, good results. I hate it when she has to be on prednisone an Clavamox, but have done this for her a couple times of year to get it under control. I’ve heard good info about Healthy Mouth, so thought I would give it a try.

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