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Journal of Feline Medicine and Surgery Journal of Feline Medicine and Surgery http://jfm.sagepub.com/ Polyostotic hyperostosis in a domestic shorthair cat Anne Fawcett, Richard Malik, C Rolfe Howlett, Michelle M McDonald, John Culvenor, Roy Pool and Graeme S Allan Journal of Feline Medicine and Surgery 2014 16: 432 DOI: 10.1177/1098612X14530216 The online version of this article can be found at: http://jfm.sagepub.com/content/16/5/432 Disclaimer The Journal of Feline Medicine and Surgery is an international journal and authors may discuss products and formulations that are not available or licensed in the individual reader's own country. Furthermore, drugs may be mentioned that are licensed for human use, and not for veterinary use. Readers need to bear this in mind and be aware of the prescribing laws pertaining to their own country. Likewise, in relation to advertising material, it is the responsibility of the reader to check that the product is authorised for use in their own country. The authors, editors, owners and publishers do not accept any responsibility for any loss or damage arising from actions or decisions based on information contained in this publication; ultimate responsibility for the treatment of animals and interpretation of published materials lies with the veterinary practitioner. The opinions expressed are those of the authors and the inclusion in this publication of material relating to a particular product, method or technique does not amount to an endorsement of its value or quality, or the claims made by its manufacturer. Published by: International Society of Feline Medicine American Association of Feline Practitioners and http://www.sagepublications.com Additional services and information for Journal of Feline Medicine and Surgery can be found at: Email Alerts: http://jfm.sagepub.com/cgi/alerts Subscriptions: http://jfm.sagepub.com/subscriptions Reprints: http://www.sagepub.com/journalsReprints.nav Permissions: http://www.sagepub.com/journalsPermissions.nav >> Version of Record - May 2, 2014 What is This? Downloaded from jfm.sagepub.com at UNSW Library on June 10, 2014 Journal of Feline Medicine and Surgery (2014) 16, 432–440 CASE REPORT Polyostotic hyperostosis in a domestic shorthair cat Clinical presentation: An 11-year-old male neutered domestic shorthair cat was presented for investigation of weight loss and inappetence. On physical examination there was palpable enlargement and thickening of many bones, and this finding was confirmed radiographically. Anne Fawcett Proposed diagnosis: Based on clinical, radiological and histopathological findings, a polyostotic bone BA(Hons) BSc(Vet)(Hons) BVSc(Hons) MVetStud1,2 disease, best described as generalised idiopathic hyperostosis, was diagnosed. This condition has not been reported in cats previously. Canine and human diseases with similarities to this presentation are discussed. Richard Malik DVSc DipVetAn MVetClinStud PhD FACVSc FASM3 Clinical report C Rolfe Howlett swollen back legs’ and was ‘very thin’. How - BVSc PhD MACVSc FBSE4 ever, the officer was unable to perform a Michelle M McDonald An 11-year-old male neutered domestic short- complete physical examination due to the BMedSci PhD5 hair cat (3.0 kg) was presented with inappe- cat’s fractious nature. John Culvenor tence and weight loss. It had been adopted The owners reported that the cat appeared BVSc MVSt FACVSc6 in Japan as a stray with two presumed litter- to have had lifelong valgus deformity of both Roy Pool mates, all found together in a cardboard box, carpi and had never jumped up higher than 7 DVM PhD when the litter was approximately 8 weeks of 30 cm. The cat had a history of chronic con - Graeme S Allan age. At 3 years old an elevation of one of the stipation (untreated) and, more recently, MVSc FACVSc DipACVR DVSc8 cat’s liver enzymes (not specified in the his - dysphagia, specifically difficulty prehending 1Sydney Animal Hospitals tory) was detected during dry food. Both cats lived – Inner West, a routine health screen. strictly indoors and both 1a Northumberland Avenue, The cat was fed Hill’s l/d ate dry urinary s/o Stanmore, NSW 2048, Australia for 2 years subsequently, (Royal Canin) and 2Faculty of Veterinary but the owners could not canned Hill’s c/d diet, Science, University of recall whether the diet Sydney, Camperdown, presumably due to a NSW 2006, Australia was discontinued due to urinary tract condition of 3Centre of Veterinary normalisation of liver one or both cats which Education, B22 University of Sydney, Camperdown, enzyme activity or for was not explained in the NSW 2006, Australia convenience. case notes from overseas. 4 Vetnostics, 60 Waterloo One of the littermates Vaccinations were cur- Road, North Ryde, NSW 2113, Australia was euthanased due to rent and there was no 5Garvan Institute of Medical advanced chronic kidney history of trauma. Research, Darlinghurst, disease at approximately NSW 2010, Australia Physical examination 6North Shore Veterinary 9 years of age. The owners Specialist Centre, relocated to Australia in The cat was alert and 64 Atchinson Street, Crows Nest, NSW 2065, Australia 2007 with the remaining responsive on presenta- 7Department of two cats, then 9 years old. tion. Physical examina- Pathobiology, College of On arrival, a veteri - tion was difficult due to Veterinary Medicine and Biomedical Sciences, Texas narian for the Australian the cat’s aggressive A&M University, College Quarantine Inspection behaviour. It was thin Station, TX 7784, USA 8 Service noted that this (body condition score Veterinary Imaging Figure 1 The cat on presentation. Note the marked Associates, St Leonards, particular cat had carpal valgus and plantigrade hindlimb stance 2/5). Palpation revealed NSW 1590, Australia ‘deformed front legs, extensive thickening of Corresponding author: Anne Fawcett, [email protected] Date accepted: 17 February 2014 DOI: 10.1177/1098612X14530216 432 JFMS CLINICAL PRACTICE Downloaded from jfm.sagepub.com at UNSW Library on June 10, 2014 © ISFM and AAFP 2014 C A S E R E P O R T / Polyostotic hyperostosis in a cat Figure 3 Close-up of the paw pads, showing the peeling epithelial surface diagnostic possibilities included acromegaly, generalised osteomyelitis, osteopetrosis or a disorder of calcium metabolism. Laboratory testing Figure 2 Marked thickening of the hock with fur loss over A complete blood count revealed a mild neu- x 9 bony prominences trophilia (16.4 10 /l; reference interval [RI] x 9 x 2–13 10 /l) and marginal monocytosis (0.8 9 x 9 10 /l; RI <0.7 10 /l). Serum biochemical the mandible and long bones. Range of abnormalities included hypernatraemia (164 motion of the proximal appendicular joints mmol/l; RI 144–158 mmol/l), hyperchloraemia was markedly reduced. There was pro- (125 mmol/l; RI 106–123 mmol/l), increased nounced carpal valgus (Figure 1) and marked urea (26.4 mmol/l; RI 5–15 mmol/l) consistent thickening of the hocks (Figure 2). Abdominal with dehydration and likely pre-renal azo- palpation revealed a large column of hard fae- taemia, and increased alkaline phosphatase (51 ces in the colon. All paw pads had a peeling mmol/l; RI 5–10 mmol/l) concentrations. Total epithelial surface (Figure 3). The cat was mild- A notable thyroxine concentration was unremarkable (13 ly hypothermic (rectal temperature 36.7°C). radiographic nmol/l; RI 10–61 nmol/l). Urinalysis revealed The patient was considered to have gener- reduced concentrating ability (urine specific alised skeletal disease, most likely due to an feature was gravity 1.028), mild proteinuria (1+) and inborn error of bone metabolism. At that time marked haematuria (4+). Based on failure to our conclusions were that the history was not bilaterally adequately concentrate urine in the face of consistent with hypervitaminosis A and other symmetrical dehydration, a diagnosis of chronic kidney disease (IRIS stage 1A) was made. uniform The serum parathyroid hormone concentra- thickening of tion (28.6 pg/ml; RI 22–168 pg/ml), 25- hydroxy-vitamin D3 concentration (106 the mandibular nmol/l; RI 88–168) and insulin-like growth factor-1 (395 µg/l; RI <800 µg/l) were all rami. normal. Serology for leishmaniasis (Kalazar ELISA), ehrlichiosis (Ehrlichia canis IFA) and anaplasmosis (complement fixation test) were all negative. In-house serology for feline immunodeficiency virus (FIV) antibodies and feline leukaemia virus (FeLV) antigen (Anigen Rapid FIV Ab/FeLV Ag Test Kit, Bionote) was negative. Diagnostic imaging Radiographs of the appendicular and axial skeleton were obtained under general anaes- thesia. A notable radiographic feature of the Figure 4 Ventrodorsal images taken in March 2009 included bilater- radiograph of the head demonstrating thickened ally symmetrical uniform thickening of the mandibular rami mandibular rami (Figure 4) (thickness from Downloaded from jfm.sagepub.com at UNSW Library on June 10, 2014 JFMS CLINICAL PRACTICE 433 C A S E R E P O R T / Polyostotic hyperostosis in a cat Figure 5 Lateral radiograph of the skull and cervical spine. Note the thickened skull and Figure 6 Mediolateral view of the left forelimb. The humerus, mandibles and the coarse trabecular pattern in the vertebrae radius, ulna and metacarpals all demonstrate hyperostosis the axial to abaxial surface of the rami was 19 mm [left] and 20 mm [right]). The mandibu- lar bone was smoothly mar- ginated with homogeneous radiopacity. There was no evi- dence of cancellous bone in either mandibular ramus, all bone appearing to be cortical in morphology. In the skull the frontal bone and the cal- varium were uniformly thick- ened (5 mm and 6 mm, respectively) (Figure 5). In the forelimbs the humeri, radii, ulnae, metacarpals and phalanges of the manus were all affected in a similar man- ner, except that a narrow Figure 8 Ventrodorsal radiograph of the pelvis. A coarse medulla was present in affect- trabecular pattern is visible in the pelvis ed bones of the appendicular skeleton. The humeri meas- ured 24 mm and 26 mm diam- eter, and the paired bones of joints of the appendicular skeleton and the the antebrachii measured Figure 7 Lateral radiograph adjacent epiphyses appeared to be spared the of the right stifle and hock.
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