A 37-year-old, 89-kg, female western lowland gorilla (Gorilla gorilla gorilla) presented with acute onset of lethargy, anorexia, reduced movement, and self-isolation in late September 2003. Diagnostic exams revealed a urinary tract infection, leukocytosis, neutrophilia with left shift, lymphopenia, nonregenerative anemia, azotemia, hypoalbuminemia, hyponatremia, hypochloremia, and hypophosphatemia. Ultrasonography and palpation identified a 12-cm diameter uterine mass. Initial antibiotic treatment with amoxicillin trihydrate/clavulanate potassium, 12.22 mg/kg PO BID (GlaxoSmithKline, Research Triangle Park, NC, USA), was changed to cephalexin 5.69 mg/kg PO BID (CEPH International Corp., Cranbury, NJ, USA) according to sensitivities and recommendations for renal patients.1 The uterine mass was first described in December 2000 as a 5-cm diameter leiomyoma.
On day 4 after presentation, the gorilla was immobilized for 12 h of peritoneal dialysis due to increased severity of azotemia and a severe hyponatremia. Peritoneal dialysis resulted in a slight reduction of BUN (4.4%) and creatinine (1.7%), and normalization of serum sodium.
Hemodialysis was performed on day 6 after presentation. The hemodialysis treatment lasted 4 h. Hemodialysis resulted in reductions of BUN (38%) and creatinine (33%), an improved attitude, and increased fluid consumption. On day 7 post presentation during preparations for whole blood transfusion the gorilla progressively weakened, went into respiratory arrest, and died.
Necropsy revealed septic shock as the cause of death. Lesions included chronic severe bilateral suppurative pyelonephritis with multifocal abscesses from which Escherichia coli, Enterococcus sp., Streptococcus intermedius, and Candida glabrata were cultured. A 14×12×12 cm well-differentiated uterine leiomyosarcoma tightly occupied the pelvis and had adhesions to surrounding structures. The ureters cranial to the uterine mass were dilated.
This case serves as an example of the successful reduction of azotemia via hemodialysis in a zoo setting. It also suggests that uterine smooth muscle neoplasia in gorillas may cause disease over time.
The author would like to thank Sidney Marcum, MD, Charles Oberst, MD, Barbara Weakley-Jones, MD, Gerald Temes, MD, Ellen Dutscke, Clair Meena Leist, MD, and Fresenius Medical Care North America.
1. Aronoff, G. R., J. S. Berns, M. E. Brier, T. A. Golper, G. Morrison, I. Singer, S. K. Swan, and W. M. Bennet. 1999. Drug Prescribing in Renal Failure: Dosing Guidelines for Adults. 4th ed. American College of Physicians-American Society of Internal Medicine, Philadelphia, PA. Pp. 176.