Hypertrophic osteopathy (Marie's disease) in a dog.
Hypertrophic Osteopathy is a condition that affects long bones but is usually secondary to primary thoracic mass involving pulmonary or less commonly the cardiovascular system and occasionally abdominal organs (Manley,1995). It has been described as a well characterized paraneoplastic syndrome that occurs uncommonly in dogs and rarely in cats, which is most often associated with primary intrathoracic masses (Henry, Carolyn, 2010). This disorder is characterized by progressive periosteal proliferation along the shafts of long bones of distal extremities (Henry loc.cit). Other synonyms for the condition include Hypertrophic pulmonary osteoarthropathy, hypertrophic pulmonary osteopathy and Marie's disease (Manley, P. loc.cit)
History and Clinical presentation
A four year old female German Shepherd dog was presented with history of anorexia, listlessness, difficulty in walking and swelling of all limbs for last one month without any improvement following treatment. On clinical examination, dog was found to be emaciated with severe cough, dyspnoea and pronounced swelling of all limbs. The mucous membranes were pale, heart and lung sounds were abnormal and general condition of animal appeared poor. However the unusual feature was, on physical examination the entire length of swollen limbs appeared unusually hard as if ossified and not edematous/pitting on pressure as one would expect. The animal had stiff gait and difficulty in walking (Fig. 1 and 2). The ECG was suggestive of congestive heart failure with atrial fibrillation, uneven QRS complexes and tachycardia (Fig. 3). As the general condition of the animal was very poor, radiograph of thorax was deferred until the next day. Hematology and serum biochemistry revealed normal values of most parameters like total leucocyte count, total platelet count, serum creatinine and serum ALT. However the hemoglobin level was 2.5 g%.
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Diagnosis and Treatment
Based on clinical signs, the condition was tentatively diagnosed as hypertrophic osteopathy which is a rather uncommon condition in dogs as well as other species. It was treated with Enrofloxacin (a) @ 5mg/ kg b. wt. IM and Meloxicam (a) @ 0.5 mg/ kg b. wt. IM and Enalapril @ 0.5mg/kg b. wt. twice daily orally. Though the animal appeared dehydrated, fluid therapy was not done because of cardiac involvement and anemia. Blood transfusion was suggested and owner were advised regarding the prognosis. The dog however did not come back the next day.
Hypertrophic osteopathy is a generalized osteoproductive disorder of periosteum that affects long bones of extremities and is usually caused by a cardiopulmonary disease most often neoplasia (Henry, Carolyn, 2010). It is manifested as a gradual swelling of all four limbs associated with pain and lameness which on palpation appears as a hard/firm swelling. The pathogenesis of hypertrophic osteopathy is incompletely understood but the most consistent feature is believed to be increased blood flow to extremities resulting in overgrowth of connective tissue and subsequent osteoneogenesis manifested as fibrochondroid metaplasia and subperiosteal new bone formation (Allan, 2007, Johnson, 2010). The increased blood supply is due to stimulation of afferent neural pathways originating in thorax and associated with vagus nerve (Manley, 1995). The treatment is usually directed at the underlying thoracic disease (neoplasia etc) using surgical methods or vagotomy (Renen et al., 2008, Renen et al., 2004). Once the source of afferent impulses is removed, the condition is said to resolve very gradually over a period of time (Johnson, loc.c/'t).However when this is not feasible due to poor body condition of animal as in the present instance, pain management with anti-inflammatory doses of steroids and NSAIDs is advocated (Henry loc.cit).
An unusual case of hypertrophic osteopathy in a four year old German Shepherd dog is reported.
Allan, G.S. (2007). Radiographic signs of joint disease in dogs and cats.In: Textbook of Veterinary Diagnostic Radiology. Ed V; Saunders Elsevier: 351
Henry, Carolyn, J. (2010). Paraneoplastic Syndrome. In. Textbook of Veterinary Internal Medicine-Diseases of the Dog and Cat. Ed VII. Saunders Elsevier. Vol II. 2214
Johnson, K. A. (2010). Skeletal Diseases . In .Texbook of Veterinary Internal Medicine-Diseases of the Dog and Cat. Ed VII. Saunders Elsevier. Vol I. 835-836
Manley, P. (1995). Diseases affecting bone. In. The Small Animal Orthopaedics, Edn Olmstead, M.L., Mosby Missouri
Renen, E. E., Lavy, I., Aizenberg. (2008). Esophageal sarcomas in dogs .Histological and clinical evaluation. Vet. J: 178.78-84.
Renen, E. E., Shamir, M.H., Shahar, R. (2004). Partial esophagectomy with single layer closure for treatment of esophageal sarcomas in six dogs. Vet Surg. 33. 428-434.
(a)--Brand of Intas Animal Health, Ahmedabad
M.A. Kshama (1) and C.A. Kamran
Veterinary College Karnataka Veterinary, Animal Fisheries Sciences University (KVAFSU) Hebbal Bengaluru--560024 (Karnataka)
(1.) Corresponding author.
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|Title Annotation:||Short Communication|
|Author:||Kshama, M.A.; Kamran, C.A.|
|Date:||Jan 1, 2016|
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