Department of Veterinary Medical Sciences, Alma Mater Studiorum-University of Bologna, Ozzano dell'Emilia, Italy.
Open Vet J. 2023 Aug;13(8):1027-1031. doi: 10.5455/OVJ.2023.v13.i8.9. Epub 2023 Aug 31.
Furosemide is a mainstay of treatment in congestive heart failure (CHF) and is widely prescribed to dogs and cats by several formulations, including the subcutaneous one. In canine and human medicine, dermatologic adverse effects of subcutaneous furosemide (SF) have been documented; conversely, no prior case has been published describing skin reactions to this therapeutic protocol in cats. In this report, we describe, for the first time in feline medicine, a suspected dermatologic adverse effect after SF in a cat.
A 2-year-old domestic shorthair cat was presented for CHF associated with lung edema and pleural effusion. Echocardiography revealed asymmetric left ventricular myocardial thickening and severe left atrial dilation. The cat was hospitalized and initially treated with oxygen, intravenous furosemide, and clopidogrel. After discharge, the route of administration of furosemide was switched from intravenous to oral. Within the following 2 weeks, the cat experienced two relapses of lung edema despite the progressive increase of the furosemide dose, the addition of spironolactone and adherence to the therapeutic protocol by the owners. The dose of furosemide was further increased and its route of administration at home was switched from oral to parental. As the owner was not able to administrate intramuscular injections, SF was prescribed. This allowed the prevention of further episodes of lung edema. However, although the cat had never presented skin problems before, multiple well-defined circular, crusted ulcerative cutaneous lesions associated with alopecia developed at the sites of furosemide injections 2 weeks later. After ruling out several differential diagnoses for these lesions, a rare side effect of furosemide, not yet described in cats but already known in canine and human medicine, was strongly suspected as the possible cause. Therefore, the ongoing injectable formulation of furosemide was interrupted and substituted with an alternative brand, maintaining the same dose and route of administration. Thanks to this change, the dermal ulcerations disappeared within 1 month. Subsequently, the cat experienced neither further skin problems nor a recurrence of lung edema.
Although SF is sometimes prescribed in small animal practice, it should be noticed that this may lead to dermatologic adverse reactions in the cat.
呋塞米是充血性心力衰竭（CHF）治疗的主要药物，有多种制剂（包括皮下制剂）被广泛用于犬猫。在犬和人类医学中，已经记录了皮下呋塞米（SF）的皮肤不良反应；相反，目前尚无先前的病例报告描述过这种治疗方案在猫中引起的皮肤反应。在本报告中，我们首次在猫科医学中描述了一例 SF 后疑似皮肤不良反应的病例。
一只 2 岁的家养短毛猫因伴有肺水肿和胸腔积液的 CHF 而就诊。超声心动图显示左心室心肌不对称增厚和严重的左心房扩张。该猫住院并接受了吸氧、静脉注射呋塞米和氯吡格雷治疗。出院后，呋塞米的给药途径从静脉改为口服。在接下来的 2 周内，尽管呋塞米剂量逐渐增加、加用螺内酯并遵循治疗方案，但该猫仍两次复发肺水肿。进一步增加了呋塞米的剂量，并将其在家中的给药途径从口服改为胃肠外。由于主人无法进行肌肉注射，因此开具了 SF。这有助于预防进一步的肺水肿发作。然而，尽管该猫以前从未出现过皮肤问题，但在 SF 注射 2 周后，注射部位出现了多个界限清楚的圆形、结痂溃疡性皮肤病变，伴有脱毛。在排除了这些病变的几种鉴别诊断后，强烈怀疑这是呋塞米的一种罕见副作用，虽然尚未在猫中描述，但已在犬和人类医学中有所了解。因此，停止了正在进行的呋塞米注射制剂，并改用替代品牌，保持相同的剂量和给药途径。由于这种改变，皮肤溃疡在 1 个月内消失。此后，该猫既未出现进一步的皮肤问题，也未复发肺水肿。
虽然 SF 在小动物临床实践中有时会被开具，但应注意，这可能会导致猫出现皮肤不良反应。
