Iatrogenic Primary Hypothyroidism Associated With Sulfamethoxazole-Trimethoprim Treatment of Nocardiosis in a Cat

IF 2.1 2区 农林科学 Q1 VETERINARY SCIENCES
Deborah Alexander, Gustavo C. Cobucci, Cassia C. da Motta, Gabriela de C. Cid, Lana S. Belizzi, Amanda C. de Jesus, Heloisa J. Souza, Mark E. Peterson
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Abstract

A 9-year-old mixed breed cat with a history of recurrent ulcerated skin lesions was diagnosed with nocardiosis. Three months after initiating potentiated sulfonamide treatment, the cat developed goitrous hypothyroidism, characterized by palpable enlargement of both thyroid lobes, low serum concentrations of total thyroxine (T4) and free thyroxine (fT4), and high serum thyroid-stimulating hormone (TSH) concentration. Thyroid scintigraphy identified symmetrical enlargement of both thyroid lobes, with increased radionuclide (99mTc-pertechnetate) uptake. Upon discontinuation of trimethoprim-sulfa, serum concentrations of T4, fT4, and TSH returned to normal, confirming the diagnosis of iatrogenic, drug-induced thyroid dyshormonogenesis leading to hypothyroidism. A skin lesion was surgically removed, and microscopy disclosed branched filaments along with characteristic Gram-positive coccobacilli and Splendore-Hoeppli phenomenon. Using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS), the clinical isolate was identified as Nocardia puris.

Abstract Image

医源性原发性甲状腺功能减退与磺胺甲恶唑-甲氧苄啶治疗猫诺卡菌病相关
一只9岁的混血猫,有复发性皮肤溃疡的病史,被诊断为诺卡菌病。在开始磺胺强化治疗3个月后,猫出现甲状腺功能减退,表现为双侧甲状腺叶明显增大,血清总甲状腺素(T4)和游离甲状腺素(fT4)浓度低,血清促甲状腺激素(TSH)浓度高。甲状腺显像显示两侧甲状腺叶对称增大,放射性核素(99mtc -高锝酸盐)摄取增加。停用甲氧苄啶磺胺后,血清T4、fT4、TSH浓度恢复正常,确诊为医源性、药物性甲状腺激素生成障碍导致甲状腺功能减退。手术切除皮肤病变,镜检发现分枝细丝伴特征性革兰氏阳性球菌和splendohoeppli现象。采用基质辅助激光解吸/电离飞行时间质谱法(MALDI-TOF MS)鉴定该临床分离物为诺卡菌。
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来源期刊
CiteScore
4.50
自引率
11.50%
发文量
243
审稿时长
22 weeks
期刊介绍: The mission of the Journal of Veterinary Internal Medicine is to advance veterinary medical knowledge and improve the lives of animals by publication of authoritative scientific articles of animal diseases.
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