개에서 발생한 후천성 중증근육무력증 일례

A Case of Acquired Myasthenia Gravis in German Shepherd Dog

  • 이상관 (조은동물병원) ;
  • 허우필 (조은동물병원) ;
  • 김연주 (경북대학교 수의과대학 수의내과학교실) ;
  • 김태완 (경북대학교 수의과대학 수의내과학교실) ;
  • 유종현 (서울대학교 수의과대학) ;
  • 엄기동 (경북대학교 수의과대학 수의내과학교실) ;
  • 오태호 (경북대학교 수의과대학 수의내과학교실) ;
  • 이근우 (경북대학교 수의과대학 수의내과학교실)
  • Lee Sang-Gwan (Joeun Animal Hospital) ;
  • Hoh Woo-Pil (Joeun Animal Hospital) ;
  • Kim Youn-Ju (College of Veterinary Medicine, Kyungpook National University) ;
  • Kim Tae-Wan (College of Veterinary Medicine, Kyungpook National University) ;
  • Yoo Jong-Hyun (College of Veterinary Medicine, Seoul National University) ;
  • Eom Ki-Dong (College of Veterinary Medicine, Kyungpook National University) ;
  • Oh Tae-Ho (College of Veterinary Medicine, Kyungpook National University) ;
  • Lee Keun-Woo (College of Veterinary Medicine, Kyungpook National University)
  • 발행 : 2005.12.01

초록

체중 32kg의 3년령 암컷 독일셰퍼드가 식이역류와 구토로 내원하였다. 신체검사에서 체중감소, 음성변화, 유연 및 후구유약이 관찰되었다. 방사선검사에서 거대식도가 관찰되었다. Neostigmine challenge test는 음성이었으며 acetyle\choline receptor에 대한 항체가는 1.58nmol/L로 양성이었다. 따라서 후천성 중증 근육무력증의 만성형으로 진단하였다. Pyridostigmine bromide 1mg/kg을 1일 2회 투여하여 치료하여 후구의 유약 증상은 현저히 개선되었고, 정상보행을 보였다. 치료과정중 이물성 폐렴이 발생하였고, 항생제 치료를 실시하였으나 관리의 어려움과 경제적 문제로 인한 보호자의 요구로 안락사 시켰다.

A three-year old intact female German shepherd dog weighing 32kg was presented with the history of regurgitation and vomiting. Physical examination revealed a thin body condition, hoarse voice, hypersalivation, and pelvic limb weakness. In radiograph, meagaesophagus was identified. The neostigmine challenge test was positive. The titer of acetylcholine receptor (AChR) antibody was 1.58 nmol/L (reference range, <0.6nmol). Therefore, the dog was diagnosed to be suffering with chronic generalized form of acquired myasthenia gravis and followed by treatment with pyridostigmine bromide, 1mg/kg, q12 hrs. Treatment improved the pelvic limb weakness, however intermittent regurgitation and vomiting persisted. This resulted in aspiration pneumonia f3r which antibiotics were administered However, the dog was euthanized due to poor management and owner's request.

키워드

참고문헌

  1. Inzana KD. Peripheral nerve disorder. In: Textbook of veterinary internal medicine 6th ed. St. Louis, Elsevier Sanunders Inc. 2005: 887-900
  2. King LG. Medical management of the critical myasthenia patient. In: Proceedings of the 16th American College of Veterinary Internal Medicine Forum. San Diego 1998: 311-313
  3. Lindstrom J, Shelton D, Fujii Y. Myasthenia gravis. Adv Immunol 1988; 42: 233-284 https://doi.org/10.1016/S0065-2776(08)60847-0
  4. Osserman KE, Genkins G. Studies in myasthenia gravis. Review of a twenty-year experience in over 1200 patients. Mt Sianai J Med 1971; 38: 497-537
  5. Shelton GD. Acquired myasthenia gravis: what we have learned from experimental and spontaneous animal models. Vet Immunol lmmunopathol 1999; 69: 239-249 https://doi.org/10.1016/S0165-2427(99)00058-6
  6. Shelton GD. Myasthenia gravis and disorders of neuromuscular transmission. Vet Clin North Am Small Anim Pract 2002; 32: 189-206 https://doi.org/10.1016/S0195-5616(03)00085-8
  7. Shelton GD. Myasthenia gravis. Lessons from the past 10 years. J Small Anim Pract 1998; 39: 368-372 https://doi.org/10.1111/j.1748-5827.1998.tb03734.x
  8. Shelton GD, Schule A, Kass PH. Risk factors for acquired myasthenia gravis in dogs: 1,154 cases (1991-1995). J Am Vet Med Assoc 1997: 211: 1428-1431