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Elaphe Schrenckii 한국가축위생학회지 제41권 제3호 (2018) Korean J Vet Serv, 2018, 41(3), 217-220 Korean Journal of ISSN 1225-6552, eISSN 2287-7630 Veterinary Service https://doi.org/10.7853/kjvs.2018.41.3.217 Available online at http://kjves.org <Case Report> Myocardial degeneration in Russian rat snake (Elaphe schrenckii) Shraddha Tiwari1, Sulhi Aufa1, Hyung-Hun Park1, Ho-Seong Cho2, Byung-Yong Park3, Yeonsu Oh1* 1Department of Veterinary Pathology, Collage of Veterinary Medicine and Institute of Veterinary Science, Kangwon National University, Chuncheon 24341, Korea 2College of Veterinary Medicine and Veterinary Diagnostic Center, 3College of Veterinary Medicine and Bio-safety Research Institute, Chonbuk National University, Iksan 54596, Korea (Received 10 June 2018; revised 13 September 2018; accepted 16 September 2018) Abstract A female Russian rat snake, Elaphe schrenckii, was presented for loss of movement. Physical examina- tion showed the swelling in the area of heart. Radiographic examination revealed cardiomegaly, peri- cardial effusion, and a soft opacity in the area of swelling. Although pericardiocentesis to remove fluid out from the heart as well as vigorous treatments were given to the Russian rat snake, it died during treatments. Postmortem examination confirmed pericardial effusion of pale yellow, translucent fluid with mild dilation of the right atrium and ventricle. Formalin -fixed paraffin embedded tissue sections were stained with routine H&E and the classical von Kossa's method for histopathological demonstration. Histopathological examination revealed multifocal calcification in myocardium and consists of the dis- placement of muscular fiber by limy deposits. Congestive heart failure was suspicious for the snake when it was alive. In wild reptiles, muscle degeneration has been reported with nutrition disorders but the present case is the first report of myocardial degeneration in a Russian rat snake and contributes to the rare reports of cardiac disease in snakes. Key words : Calcification, Myocardial degeneration, Elaphe schrenckii, Radiographic, Russian rat snake INTRODUCTION Jensen et al, 2010b). Cardiac disease is only rarely re- ported in snakes and other reptiles (Schroff et al, 2010) Heart disease in reptiles is a group of pathological and includes both primary (idiopathic cardiomyopathy, entities that remains uncommonly diagnosed, and most congenital defects, degenerative disease) and secondary available information about cardiovascular disease is (metabolic and nutritional) disorders (Schroff et al, based on necropsy examination findings (Kik and Mitchell, 2010). Clinical signs are often nonspecific and include 2005). Given that cardiac structure of snakes is quite generalized weakness, anorexia, weight loss, skin dis- different from mammals, it is important to be fully coloration, swelling of the cardiac area, edema, ascites, aware of the normal anatomy and physiology of reptiles cyanosis, ecchymosis, and sudden death (Murray, 2006). prior to surgery or postmortem examination (Farrell et al, 1998; Girling and Hynes, 2004; Murray, 2006; Starck, 2009; Wyneken, 2009; Jensen et al, 2010a; CASE *Corresponding author: Yeonsu Oh, Tel. +82-33-250-8792, A pregnant Russian rat snake (Elaphe schrencki) of Fax. +82-33-259-5625, E-mail. [email protected] The first two authors contributed equally to this work. unknown age which presented a pronounced enlarge- Copyright © 2018, The Korean Society of Veterinary Service. All Rights Reserved. 217 218 Shraddha Tiwari, Sulhi Aufa, Hyung-Hun Park, Ho-Seong Cho, Byung-Yong Park, Yeonsu Oh ment of the cardiac region and inability for physical effusion, and a soft opacity superimposed over the car- movement, was rescued to the Kangwon National diac silhouette (Fig. 1B). The pericardiocentesis was University Veterinary Teaching Hospital in a winter given to the baby snake as its mother through ultra- season. The full radiography confirmed extensive peri- sonography-guided to remove serosanguinous fluid from cardial effusion (Data not shown), and serosanguinous the heart. Despite all these treatments, the baby snake fluid was collected through the ultrasonography-guided did not survive, and an autopsy was performed pericardiocentesis. Multiple trials of antibiotic treatments immediately. and supplemental therapy did not improve the general Gross pathological examination on abdominal organs condition. The mother snake gave birth to six eggs and revealed that there was no infection or sepsis, but in- died during the treatment, and a postmortem examina- stead it was shrunken in size due to malnutrition as its tion followed. mother. Moderate amount of pale yellow, translucent The abdominal organs did not seem to be affected by fluid was observed in the opened pericardial sac and any infection or sepsis, rather shrunken due to malnu- right atrium and ventricle were observed to be dilated. trition, but it was not surprising that the animal was in When an incision of heart was made, a gritty con- hibernation. However, when it was rescued, it was seen sistency on the cutting surface was noted. The tissue outside with cardiac region enlargement and all of six samples from the heart was taken for further histopatho- neonates presented the same symptom with their mother. logical examination. The five neonates were dead five hours after being Tissue specimens were fixed in 10% (w/v) neutral hatched. The one remaining neonate, 65 cm in length buffered formalin solution and then trimmed and rou- and 55 g in weight, was lethargic, thin and weak, and tinely processed, embedded in paraffin, sectioned at ap- also presented cardiac region enlargement just like its proximately 4 to 5 mm using a Leica RM 2235 CWEU mother (Fig. 1A). Treatments for the young snake were microtome. The slides were stained with Hematoxylin given for suspected trans-shell infective carditis, starting and Eosin (H&E) and then subjected to a microscopic with ceftazidime, 10 mg/kg (FortumⓇ; GlaxoSmithKline examination (Oh and Cho, 2017). Additional heart sec- GmbH & Co.KG, Munchen, Germany) intramuscularly tions were conducted for the histochemical demon- every 48 hr, 20 ml/kg of a mixture of Ringer’s solution stration of calcium salts. The slides were stained with as a supportive fluid therapy subcutaneously every 24 hr the classical von Kossa’s method (Chaplin and Grace, (Delta Select GmbH, Dreidech, Germany), 25% of ami- 1975). Briefly, the slide was treated with a silver nitrate no acids (VolaminⓇ; Merial GmbH, Hallbergmoos, solution until the silver being deposited by replacing the Germany), 5% of glucose (Baxter Deutschland GmbH, calcium in the presence of strong light. Then, it was vi- Unterschleißheim, Germany), and 0.5% of calcium gluc- sualized as metallic silver. After counterstaining, the onate (B. Braun Melsungen AG, Melsungen, Germany; slide was dehydrated and mounted. Histopathologically, 0.5%). For radiographic examination, lateral projection heart tissue showed necrosis of cardiomyocytes (Fig. was performed and revealed cardiomegaly, pericardial 2A) evidenced by cytoplasmic swelling, vacuolization Fig. 1. Russian rat snake (Elaphe schrencki). A. Pronounced en- largement of the cardiac region. B. A B Cardiomegaly, Radiography. Korean J Vet Serv, 2018, Vol. 41, No. 3 Myocardial degeneration in Russian rat snake 219 A B C Fig. 2. Russian rat snake (Elaphe schrencki). A. Myocyte necrosis, heart. H&E. Scale bar=200 m. B. Tissue calcification, heart. H&E. Scale bar=50 m; C. Myocardial calcification, heart. Von Kossa’s silver stain. Scale bar=20 m. and hyalinization which probably preceded gross tices (Madar, 1996). calcification. Tissue calcification (Fig. 2B), myocardial Classically, cardiac calcification has two main pat- calcification (Fig. 2C), and displacement of muscular fi- terns, dystrophic and metastatic, and the latter was the bers by limy deposits were observed. Area of calcifica- most common in reptiles (Gore and Aron, 1949). tion were scattered throughout the ventricle and it was Dystrophic mineralization of arteries was seen in various greater in ventricle being able to be seen by naked eyes. lizards (Chinnadurai et al, 2008; Borza and Bolfa, 2012) Based on histopathology findings, this snake has severe associated most likely with renal failure, tissue trauma, myocardial degeneration. The snake had worsening dia- hypervitaminosis D, and other metabolic disturbances, stolic dysfunction before death that was thought to be whereas metastatic calcification due to the secondary nu- related to the extensive calcifications, emphasizing the tritional hyperparathyroidism (Kik and Mitchell, 2005) clinical finding. was reported in a Chinese water dragon (Physignathus concincinus). Ruptured aorta was induced by mineraliza- tion secondary to hyperparathyroidism and a mandibular DISCUSSION abscess. The pathogenesis associated with malnutrition remains to be understood. However, it is thought that Although a great knowledge regarding the physiology vitamin D may play an important role (Allen, 2003). In and evolutionary importance of the reptile heart has our case, the snake have calcification in myocardial fi- been assembled, but the clinical implication in veteri- bers that was suspicious of nutritional cause. Myocardial nary medicine has presented limited attentions (White, degeneration in several reptiles species has been re- 1976). Reptile cardiology may be considered to be its ported due to vitamin E deficiency (Frye, 1991). infancy (Kik and Mitchell, 2005). A detail description The heart of reptiles can be affected by
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