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Perry KM, Enders BD, Negrão Watanabe TT. Refractory shock, hypercoagulability, and multiorgan thrombosis associated with hypertrophic osteodystrophy in a dog. J Vet Emerg Crit Care (San Antonio) 2023; 33:257-262. [PMID: 36799891 DOI: 10.1111/vec.13280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 02/07/2022] [Accepted: 02/26/2022] [Indexed: 02/18/2023]
Abstract
OBJECTIVE To describe the clinical findings and case progression in a dog presenting with severe systemic inflammatory response, refractory shock, progressive metabolic acidosis, and respiratory failure that was ultimately diagnosed with hypertrophic osteodystrophy (HOD). CASE SUMMARY A 4-month-old male intact Mastiff presented with a 24-hour history of lethargy and generalized ostealgia. On examination, the dog was recumbent, febrile, and tachycardic with pain on palpation of the abdomen, right femur, and mandible. Appendicular joint radiographs showed changes consistent with osteochondrosis and ulnar-retained cartilaginous cores, with no overt evidence of HOD. Initial treatment included IV fluid therapy, multimodal analgesia, and broad-spectrum antimicrobials. Vasopressor therapy was initiated following hemodynamic decompensation. Synovial fluid cytological analysis and culture revealed nonseptic suppurative inflammation and no bacterial growth, respectively. Blood and urine cultures also yielded no growth. Viscoelastic testing was consistent with hypercoagulability. The dog initially had a metabolic acidosis with appropriate respiratory compensation that progressed to a mixed metabolic and respiratory acidosis despite aggressive therapies that included antimicrobials, vasopressors, positive inotropes, and corticosteroids. Humane euthanasia was elected approximately 32 hours after admission. Necropsy yielded a diagnosis of HOD. NEW OR UNIQUE INFORMATION PROVIDED This is the first report detailing the occurrence of refractory shock and hypercoagulability associated with HOD in a dog without evidence of another identified comorbidity. HOD should be considered in any young, large-breed dog with generalized ostealgia and signs of systemic illness, even in the absence of classic radiographic abnormalities. Further investigation of coagulation status in dogs with HOD and a secondary systemic inflammatory response is warranted.
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Affiliation(s)
- Kayla M Perry
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | - Brittany D Enders
- Small Animal Emergency and Triage Services, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
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Robertson AL, Black VL, Villedieu E, Clarke KE, Faux I, Major A, Adamantos S. Presenting signs and clinical outcome in dogs with metaphyseal osteopathy: 39 cases (2009-2018). J Small Anim Pract 2023; 64:35-42. [PMID: 36123814 PMCID: PMC10087536 DOI: 10.1111/jsap.13554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 07/29/2022] [Accepted: 08/12/2022] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To describe the presenting signs, concurrent conditions, treatment and outcome of dogs with metaphyseal osteopathy. MATERIALS AND METHODS Multi-centre retrospective review of medical records from January 2009 to September 2018 at four referral centres to identify dogs with a radiographic diagnosis of metaphyseal osteopathy. RESULTS Thirty-nine dogs were identified. The median age at onset was 14 weeks old (range, 8 to 32 weeks old). There was a higher proportion of male dogs (29 of 39 male entire, nine of 39 female entire, one of 39 female neutered and no male neutered dogs). Where information was available, median time from the most recent vaccination was 20 days (range, 2 to 144 days). The most commonly recorded clinical signs were pyrexia (34 of 39), lethargy (32 of 39), pain (30 of 39), and being non-ambulatory (17 of 39). Thirty-five dogs required hospitalisation for analgesia and supportive care, 19 of 39 were discharged on prednisolone (median dose 2.0 mg/kg/day; range, 0.9 to 2.6 mg/kg/day), 18 of 39 were discharged on non-steroidal anti-inflammatories, two of 39 did not receive NSAIDs or prednisolone at any time point. The median duration of hospitalisation for those admitted was 5 days (range, 1 to 21 days). Where follow-up was available, relapse occurred in eight of 25 cases before reaching skeletal maturity. At the time of metaphyseal osteopathy diagnosis, five of 39 cases had concurrent conditions. Where follow-up was available, four of 25 developed future immune-mediated conditions. CLINICAL SIGNIFICANCE Metaphyseal osteopathy should be considered in non-ambulatory painful young dogs. Some dogs developed future immune-mediated conditions, which may support the hypothesis that metaphyseal osteopathy is an autoinflammatory bone disorder. Further studies with a larger cohort are required to determine the clinical significance of this.
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Affiliation(s)
- A L Robertson
- Bristol Veterinary School, University of Bristol, Bristol, BS8 1TH, UK.,The Ralph Veterinary Referral Centre, The Ralph Veterinary Referral Centre, Marlow, SL7 1YG, UK
| | - V L Black
- Bristol Veterinary School, University of Bristol, Bristol, BS8 1TH, UK
| | - E Villedieu
- Willows Veterinary Centre and Referral Service, Willows Veterinary Centre and Referral Service, Shirley, B90 4NH, UK
| | - K E Clarke
- Davies Veterinary Specialists, Davies Veterinary Specialists, Shillington, SG5 3HR, UK
| | - I Faux
- Royal (Dick) School of Veterinary Studies, University of Edinburgh, Edinburgh, EH25 9RG, UK
| | - A Major
- Langford Vets Small Animal Referral Hospital, University of Bristol, Langford, BS40 5DU, UK
| | - S Adamantos
- Langford Vets Small Animal Referral Hospital, University of Bristol, Langford, BS40 5DU, UK
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Safra N, Hitchens PL, Maverakis E, Mitra A, Korff C, Johnson E, Kol A, Bannasch MJ, Pedersen NC, Bannasch DL. Serum levels of innate immunity cytokines are elevated in dogs with metaphyseal osteopathy (hypertrophic osteodytrophy) during active disease and remission. Vet Immunol Immunopathol 2016; 179:32-5. [PMID: 27590423 PMCID: PMC5570445 DOI: 10.1016/j.vetimm.2016.08.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 07/19/2016] [Accepted: 08/03/2016] [Indexed: 12/18/2022]
Abstract
Metaphyseal osteopathy (MO) (hypertrophic osteodystrophy) is a developmental disorder of unexplained etiology affecting dogs during rapid growth. Affected dogs experience relapsing episodes of lytic/sclerotic metaphyseal lesions and systemic inflammation. MO is rare in the general dog population; however, some breeds (Weimaraner, Great Dane and Irish Setter) have a much higher incidence, supporting a hereditary etiology. Autoinflammatory childhood disorders of parallel presentation such as chronic recurrent multifocal osteomyelitis (CRMO), and deficiency of interleukin-1 receptor antagonist (DIRA), involve impaired innate immunity pathways and aberrant cytokine production. Given the similarities between these diseases, we hypothesize that MO is an autoinflammatory disease mediated by cytokines involved in innate immunity. To characterize immune dysregulation in MO dogs we measured serum levels of inflammatory markers in 26 MO and 102 control dogs. MO dogs had significantly higher levels (pg/ml) of serum Interleukin-1beta (IL-1β), IL-18, IL-6, Granulocyte-macrophage colony stimulating factor (GM-CSF), C-X-C motif chemokine 10 (CXCL10), tumor necrosis factor (TNF), and IL-10. Notably, recovered MO dogs were not different from dogs during active MO disease, providing a suggestive mechanism for disease predisposition. This is the first documentation of elevated immune markers in MO dogs, uncovering an immune profile similar to comparable autoinflammatory disorders in children.
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Affiliation(s)
- Noa Safra
- School of Veterinary Medicine, University of California, Davis, 1 Garrod Drive, Davis, CA 95616, USA.
| | - Peta L Hitchens
- School of Veterinary Medicine, University of California, Davis, 1 Garrod Drive, Davis, CA 95616, USA; Swedish University of Agricultural Sciences, Almas Allé 8, 750 07 Uppsala, Sweden
| | - Emanual Maverakis
- Department of Dermatology, University of California, Davis, 3301 C Street, Sacramento, CA 95816, USA
| | - Anupam Mitra
- Department of Dermatology, University of California, Davis, 3301 C Street, Sacramento, CA 95816, USA
| | - Courtney Korff
- School of Veterinary Medicine, University of California, Davis, 1 Garrod Drive, Davis, CA 95616, USA
| | - Eric Johnson
- School of Veterinary Medicine, University of California, Davis, 1 Garrod Drive, Davis, CA 95616, USA
| | - Amir Kol
- School of Veterinary Medicine, University of California, Davis, 1 Garrod Drive, Davis, CA 95616, USA
| | - Michael J Bannasch
- School of Veterinary Medicine, University of California, Davis, 1 Garrod Drive, Davis, CA 95616, USA
| | - Niels C Pedersen
- School of Veterinary Medicine, University of California, Davis, 1 Garrod Drive, Davis, CA 95616, USA
| | - Danika L Bannasch
- School of Veterinary Medicine, University of California, Davis, 1 Garrod Drive, Davis, CA 95616, USA
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