Philp Helen S, Farrell Kate S, Li Ronald H L
William R. Pritchard Veterinary Medical Teaching Hospital, University of California, Davis, Davis, CA, United States.
Department of Veterinary Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States.
Front Vet Sci. 2023 Feb 6;10:1118798. doi: 10.3389/fvets.2023.1118798. eCollection 2023.
Disseminated intravascular coagulation following melarsomine therapy for is reported in a 9-year-old female intact pit bull-type dog. The dog had been diagnosed with (antigen and microfilaria positive) and treated with imidacloprid, moxidectin, doxycycline and 3 doses of melarsomine over a 92-day period. Seven days after the third melarsomine injection, the patient was presented to her family veterinarian due to right pelvic limb swelling. Prothrombin and activated partial thromboplastin times were prolonged beyond the detectable range. Treatment included vitamin K1 and fresh frozen plasma (FFP) prior to referral to the authors' institution. At this time the patient remained coagulopathic. Further investigations included thoracic radiographs, abdominal ultrasound and an echocardiogram. The patient was administered multiple units of packed red blood cells and FFP, sildenafil, dexamethasone SP, aminocaproic acid and vitamin K1. Repeat CBC approximately 20 h after admission showed persistent anemia and thrombocytopenia. Despite ongoing administration of FFP, a repeat coagulation panel showed worsening of the coagulopathy with prothrombin time of 84.2s [reference interval (RI) 7.0-9.3s], activated partial thromboplastin time >140s (RI 10.4-12.9s) and fibrinogen <50 mg/dL (RI 109-311 mg/dL). Following discussion with the owners, the patient was euthanized. Necropsy was performed and confirmed heartworm infection with severe pulmonary arterial thrombosis, vascular remodeling, and intraluminal degenerate nematodes. Multifocal subcutaneous and organ hemorrhage was apparent. Although coagulopathy has been described in caval syndrome associated with heartworm disease and is listed as a potential side effect of melarsomine administration, this is the first report of documented disseminated intravascular coagulation following melarsomine treatment for . Potential mechanisms for the coagulopathy are discussed and the case report highlights a rare, but serious complication of adulticide therapy.
一只9岁未绝育的斗牛犬接受美拉索明治疗后发生弥散性血管内凝血的病例报告。该犬被诊断为心丝虫病（抗原和微丝蚴阳性），在92天内接受了吡虫啉、莫昔克丁、强力霉素治疗以及3剂美拉索明治疗。第三次注射美拉索明7天后，因右后肢肿胀，该犬被送至其家庭兽医处。凝血酶原时间和活化部分凝血活酶时间延长至检测范围之外。在转诊至作者所在机构之前，治疗措施包括维生素K1和新鲜冰冻血浆（FFP）。此时该犬仍存在凝血功能障碍。进一步检查包括胸部X光片、腹部超声和超声心动图。该犬接受了多单位的浓缩红细胞和FFP、西地那非、地塞米松磷酸钠、氨基己酸和维生素K1治疗。入院后约20小时复查全血细胞计数显示持续贫血和血小板减少。尽管持续输注FFP，但重复凝血检查显示凝血功能障碍恶化，凝血酶原时间为84.2秒[参考区间（RI）7.0 - 9.3秒]，活化部分凝血活酶时间>140秒（RI 10.4 - 12.9秒），纤维蛋白原<50mg/dL（RI 109 - 311mg/dL）。与主人讨论后，该犬实施安乐死。尸检证实有心丝虫感染，伴有严重的肺动脉血栓形成、血管重塑和管腔内变性线虫。可见多灶性皮下和器官出血。尽管在与心丝虫病相关的腔静脉综合征中已描述过凝血功能障碍，且美拉索明给药的潜在副作用中也有列出，但这是美拉索明治疗心丝虫病后记录在案的弥散性血管内凝血的首例报告。文中讨论了凝血功能障碍的潜在机制，该病例报告突出了杀虫剂治疗罕见但严重的并发症。
