Lethal peracute rhabdomyolysis associated with stress and general anesthesia in three dystrophin-deficient cats

Abstract

Three cats affected with dystrophin deficiency and hypertrophic muscular dystrophy developed peracute rhabdomyolysis with a fatal outcome. Two cats were anesthetized with isoflurane for routine procedures and did not recover properly from the anesthetic procedure. One cat was manually restrained for an echographic examination and started staggering after a short struggle; its condition worsened, and it died. Blood chemistry findings included severe hyperkalemia, hyperphosphatemia, hypocalcemia, massive increases in creatine kinase, aspartate aminotransferase, and alanine aminotransferase concentrations, and high ion gap metabolic acidosis. Light microscopic evaluation of skeletal muscle revealed severe acute rhabdomyolysis with marked extensive necrosis of large groups of fibers and endomysial edema. These lesions were observed in many skeletal muscles but particularly in the masseter and supraspinatus muscles and in the diaphragm. Typical changes associated with dystrophin deficiency in cats were also noted. Histochemical analysis revealed that the dystrophin deficiency was associated with a decrease in the percentage of type 1 myofibers in all three cats. This change was marked in the 20-month-old cat and milder in the younger cats (6.5 and 8.5 months of age). Percentages of type 2A fibers were markedly decreased and percentages of type 2X fibers were markedly increased in the younger cats. Rhabdomyolysis has been reported in dystrophinopathic humans but not in other animal models of dystrophin deficiency. An increased sensitivity of the dystrophin-deficient sarcolemmal membrane to volatile anesthetic agents, stress, or intense muscular activity is suspected.