MANAGEMENT OF ACUTE RENAL FAILURE WITH DELAYED HYPERCALCEMIA SECONDARY TOSARCOCYSTIS NEURONA–INDUCED MYOSITIS AND RHABDOMYOLYSIS IN A CALIFORNIA SEA LION (ZALOPHUS CALIFORNIANUS)

Abstract

A 3-yr-old captive-born California sea lion (Zalophus californianus) developed Sarcocystis neurona-induced myositis and rhabdomyolysis that led to acute renal failure. The sea lion was successfully managed with fluid therapy, antiprotozoals, antibiotics, anti-inflammatories, antiemetics, gastroprotectants, and diuretics, but developed severe delayed hypercalcemia, a syndrome identified in humans after traumatic or exertion-induced rhabdomyolysis. Treatment with calcitonin was added to the management, and the individual recovered fully. The case emphasizes that animals with rhabdomyolysis-induced renal failure risk developing delayed hypercalcemia, which may be life threatening, and calcium levels should be closely monitored past the resolution of renal failure.

Clinical signs, treatment, and outcome for California sea lions (Zalophus californianus) with Sarcocystis-associated polyphasic rhabdomyositis

“…Given the extensive skeletal muscle disease noted in these animals, even higher creatine kinase activities might have been expected, as documented previously in a captive CSL treated for this disease. 20 Progression of disease and concurrent increases in creatine kinase activity were observed in 2 CSLs in the present case series; however, a lack of high creatine kinase activity did not preclude severe sarcocystosis-associated polymyositis. Creatine kinase is a highly labile enzyme, and the chronicity of disease likely accounted for the normal creatine kinase activities in many of these animals.…”

“…Two dogs and a CSL with severe myositis due to sarcocystosis had high alanine transaminase activity and severe thrombocytopenia. 12,20 Sarcocystis canis-induced hepatitis has been described in multiple marine mammal species, including CSLs, [13][14][15][16]18 but serum biochemical values were not reported because the diagnosis was made on histologic examination. In the present case series, hepatic disease associated with sarcocystosis was minimal and, thus, unlikely to have contributed to increases in alanine transaminase activity.…”

“…Treatment protocols were based on recommendations for treatment of equine protozoal myeloencephalitis in horses 1 and a few anecdotal reports on marine mammals. 11,17,20 The antiprotozoal drug used was ponazuril, which was administered at a dosage of 10 mg/kg, PO, every 24 hours for 28 days. Alternative coccidiostatic antimicrobials that were used were clindamycin (10 to 15 mg/kg, IM or PO, q 12 h) and trimethoprim-sulfonamide (15 mg/kg, PO, q 12 h), administered for 28 days.…”

“…Sarcocystosis is also a documented cause of hepatic disease and myopathies in multiple species, 5,[12][13][14][15][16] including marine mammals, [13][14][15][16][17][18][19][20] but these are reported less frequently than the neurologic manifestations associated with S neurona. In addition, although Sarcocystis-associated myositis has been recognized in California sea lions (CSLs; Zalophus californianus) for at least a decade, 17,19,20 there is little published information on clinical signs and treatment strategies. 17,20 Polyphasic rhabdomyositis 19 associated with Sarcocystis spp was observed in stranded CSLs treated between 2015 and 2017 at a rehabilitation center in California.…”

“…In addition, although Sarcocystis-associated myositis has been recognized in California sea lions (CSLs; Zalophus californianus) for at least a decade, 17,19,20 there is little published information on clinical signs and treatment strategies. 17,20 Polyphasic rhabdomyositis 19 associated with Sarcocystis spp was observed in stranded CSLs treated between 2015 and 2017 at a rehabilitation center in California. The purpose of the study reported here was to describe clinical signs, treatment, and outcome for CSLs with Sarcocystis-associated polyphasic rhabdomyositis.…”