Wells Raegan J, Sedacca Cassidy D, Aman Anna M, Hackett Timothy B, Twedt David C, Shelton G Diane
Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO 80523, USA.
J Am Vet Med Assoc. 2009 Apr 15;234(8):1049-54. doi: 10.2460/javma.234.8.1049.
CASE DESCRIPTION - A 6-year-old castrated male Llewelyn Setter was evaluated because of an acute onset of myalgia and respiratory distress. CLINICAL FINDINGS - Physical examination revealed a stiff stilted gait, swollen muscles that appeared to cause signs of pain, panting, and ptyalism. The dog had a decrease in palpebral reflexes bilaterally and a decrease in myotatic reflexes in all 4 limbs. The panniculus reflex was considered normal, and all other cranial nerve reflexes were intact. Serum biochemical analysis revealed markedly high cardiac troponin-I concentration and creatine kinase and aspartate aminotransferase activities. Urinalysis revealed myoglobinuria. Results for thoracic and abdominal radiography, blood pressure measurement, and an ECG were within anticipated limits. Echocardiographic findings were consistent with secondary systolic myocardial failure. Arterial blood gas analysis confirmed hypoxemia and hypoventilation. The dog had negative results when tested for infectious diseases. Examination of skeletal muscle biopsy specimens identified necrotizing myopathy. TREATMENT AND OUTCOME - Treatment included ventilatory support; IV administration of an electrolyte solution supplemented with potassium chloride; administration of dantrolene; vasopressor administration; parenteral administration of nutrients; use of multimodal analgesics; administration of clindamycin, furosemide, mannitol, and enrofloxacin; and dietary supplementation with L-carnitine and coenzyme Q(10). Other medical interventions were not required, and the dog made a rapid and complete recovery. CLINICAL RELEVANCE - Necrotizing myopathy resulting in rhabdomyolysis and myoglobinuria can lead to life-threatening physical and biochemical abnormalities. Making a correct diagnosis is essential, and patients require intensive supportive care. The prognosis can be excellent for recovery, provided there is no secondary organ dysfunction.
病例描述 - 一只6岁去势雄性卢埃林雪达犬因急性肌痛和呼吸窘迫接受评估。临床发现 - 体格检查显示步态僵硬、高跷样，肌肉肿胀，似有疼痛迹象，气喘，流涎。该犬双侧睑反射减弱，四肢肌伸张反射均减弱。腹壁反射正常，其他所有脑神经反射均完整。血清生化分析显示心肌肌钙蛋白-I浓度、肌酸激酶和天冬氨酸转氨酶活性显著升高。尿液分析显示肌红蛋白尿。胸部和腹部X线摄影、血压测量及心电图结果均在预期范围内。超声心动图检查结果与继发性收缩期心肌衰竭一致。动脉血气分析证实存在低氧血症和通气不足。该犬传染病检测结果为阴性。骨骼肌活检标本检查确诊为坏死性肌病。治疗及转归 - 治疗包括通气支持；静脉输注补充氯化钾的电解质溶液；给予丹曲林；给予血管加压药；胃肠外营养；使用多模式镇痛药；给予克林霉素、呋塞米、甘露醇和恩诺沙星；以及补充左旋肉碱和辅酶Q10。无需其他医疗干预，该犬迅速完全康复。临床意义 - 导致横纹肌溶解和肌红蛋白尿的坏死性肌病可引发危及生命的生理和生化异常。做出正确诊断至关重要，患者需要强化支持治疗。若不存在继发性器官功能障碍，恢复预后极佳。
