Document Type: Clinical Report
Department of Clinical Sciences, Faculty of Veterinary Medicine, Lorestan University, Khorram Abad, Iran.
Graduated DVM, Faculty of Veterinary Medicine, Lorestan University, Khorram Abad, Iran.
Case Description- A five-year-old Arabian stallion weighing approximately 300 kg with large infected chronic torn wound on the neck and pectoral region 5 days after IM injection of flunixin meglumine with history of anorexia, depression and lack of response to antibacterial treatment referred to the Veterinary Teaching Hospital of Lorestan University.
Clinical Findings- The clinical symptoms observed during the examination were hematuria and watery diarrhea with very large skin laceration in the affected area. External examination revealed the infectious cervical and pectoral muscles and necrosed skin with purulent discharge and odorous smell. Skin and surrounding tissues were warm, edematous and swelled.
Treatment and Outcomes- Surgical treatment started with physical debridement and maggot therapy using Lucilia (Phaenicia) sericata. Then medical treatment continued with intravenous fluid therapy, antimicrobial and anti-inflammatory drugs (NSAID) along with topical treatment.
Clinical Relevance- The present case demonstrates the serious complications that can occur following non-sterile IM injections and/or as a consequence of flunixin meglumine IM administration. An aggressive pharmacological and surgical therapy is very essential in similar cases. In conclusion, successful management of the cutaneo-muscular necrosis depends upon the condition of wound and selection of proper antibacterial drugs along with early surgical intervention.
- Kamus L, Theoret C. Choosing the best approach to wound management and closure. Veterinary Clinic of North America Equine Practice, 2018;34(3): 499-509.
- USDA. Equine: Baseline Reference of Equine Health and Management in the United States. Section I: Population Estimates, 2015: 73-77.
- Owen KR, Singer ER, Clegg PD, Ireland JL, Pinchbeck GL. Identification of risk factors for traumatic injury in the general horse population of north-west England, Midlands and north Wales. Equine Veterinary Journal, 2012; 44(2): 143–148.
- Theoret CL, Bolwell CF, Riley CB. A cross-sectional survey on wounds in horses in New Zealand. New Zealand Veterinary Journal, 2016; 64: 90–94.
- Adam EN, Southwood LL. Surgical and traumatic wound infections, cellulitis, and myositis in horses. Veterinary Clinic of North America Equine Practice, 2006; 22: 335-361.
- Crum-Cianflone NF. Bacterial, fungal, parasitic, and viral myositis. Clinical Microbiological Review, 2008; 21: 473-494.
- Farias LD, Azevedo-Mda S, Trost ME, De La Corte FD, Irigoyen LF, De-Vargas AC. Acute myonecrosis in horse caused by Clostridium novyi type A. Brazilian Journal Microbiology, 2014; 45: 221-224.
- Peek SF, Semrad SD, Perkins GA. Clostridial myonecrosis in horses (37 cases 1985-2000). Equine Veterinary Journal, 2003; 35: 86-92.
- Rebhun WC, Shin SJ, King JM, Baum KH, Patten V. Malignant edema in horses. Journal of the American Veterinary Medical Association, 1985; 187: 732-736.
- Sedigh HS, Rajabioun M, Razmyar J, Kazemi-Mehrjerdi H. An unusual necrotic myositis by Clostridium perfringens in a German Shepherd dog: A clinical report, bacteriological and molecular identification. Veterinary Research Forum, 2015; 6(4): 349-353.
- Eggleston RB. Equine wound management: Bandages, casts, and external support. Veterinary Clinic of North America Equine Practice, 2018; 34(3): 557-574.
- Theoret CL. Physiology of wound healing. In: Equine wound management. Theoret CL, Schumacher J, editors. 3rd edition. Ames (IA): Wiley Blackwell, 2017; 1–13.
- Henneke DRPG, Kreider JL, Yeates BF. Relationship between condition score, physical measurements and body fat percentage in mares. Equine Veterinary Journal, 1983; 15: 371-372.
- Obel N. Studies on the Histopathology of Acute Laminitis. Almquisst and Wiksells Boktryckeri, 1948.
- Brooks DE. Equine ophthalmology. In: Veterinary Ophthalmology. Gelatt KN. editor, 3rd edition. Lippincott, Williams and Wilkins, Baltimore, 1998; 1053–1116.
- Turek JJ, Templeton CB, Bottoms GD, Fessler JF. Flunixin meglumine attenuation of endotoxin-induced damage to the cardiopulmonary vasculature endothelium of the pony. American Journal of Veterinary Research, 1985; 46: 591–596.
- Pellegrini-Masini A, Poppeng, RH, Sweeney RW. Disposition of flunixin meglumine injectable preparation administered orally to healthy horses. Journal of Veterinary Pharmacology and Theraputics, 2004; 27: 183–186.
- Clark JO, Clark TP. Analgesia. Veterinary Clinics of North America: Equine Practice, 1999; 15: 705–723.
- Anderson FL, Secombe CJ, Lester GD. Clostridial myonecrosis, haemolytic anaemia, hepatopathy, osteitis and transient hypertrophic cardiomyopathy after intramuscular injection in Thoroughbred gelding. Australian Veterinary Journal, 2013; 91: 204-208.
- Siddiqui AR, Bernstein JM. Chronic wound infection: facts and controversies. Clinical Dermatology, 2010; 28: 519–526.
- Wilson WD. Rational selection of antimicrobials for use in horses. Proceeding of American Association Equine Practice Annual Convention, 2001; 47: 75–93.
- Freeman KD, Southwood LL, Lane J, Lindborg S, Aceto HW. Post-operative infection, pyrexia and perioperative antimicrobial drug use in surgical colic patients. Equine Veterinary Journal, 2012; 44(4): 476–81.
- Dart AJ, Sole-Guitart A, Stashak TS, Theoret C. Management practices that influence wound infection and healing. In: Equine wound management. Theoret CL, Schumacher J, editors. 3rd edition. Ames (IA): Wiley Blackwell, 2017; 47–74.
- Dholaria S, Dalal P, Shah N. Narkhede R. Maggots debridement therapy [MDT]. Gujarat Medical Journal, 2014; 69: 1.
- Elce YA. Approaches to wound closure. In: Equine wound management. Theoret CL, Schumacher J, editors. 3rd edition. Ames (IA): Wiley Blackwell, 2017; 157–72.
- Dart AJ, Sole-Guitart A, Stashak TS. Selected factors that negatively impact healing. In: Equine wound management. Theoret CL, Schumacher J, editors. 3rd edition. Ames (IA): Wiley Blacwell, 2017; 30–46.
- Carnevali F, Argentieri M, Ippedico G, Alberto Minniti C, Amodio L, Mellano L, Andrew van der Esch S. Managing horse wounds either presenting or not with exuberant granulation tissue using an innovative wound dressing: A retrospective non-controlled study. Journal of Animal and Veterinary Sciences, 2014; 1(2): 6-16.
- Constable P, Hincheliff KW, Done S, Gruenberg W. Veterinary medicine: A textbook of the disease of cattle, horses, sheep, pigs and goats. 13: Diseases of the urinary system. Philadelphia, PA, USA. 11th edn. Saunders Elsevier, 2017.