Abstract

A 50-year-old male Asian elephant (Elaphus maximus) “Murugan” was suffering from chronic joint disease and recurring bouts of colic. Specifically, the right elbow and both carpal joints were affected, which was confirmed by infra-red thermography. The animal was kept on low doses of phenylbutazone orally. Colic was treated with metamizol + scopolamine injections and dietary measures.

Early 2002 his condition deteriorated, and he started to develop severe ventral and preputial edema. No diagnoses for the edema could be made and the condition was treated with furosemide and cortico-steroids. Urine samples and blood analysis revealed diabetes mellitus. When Murugan developed melena, showed great discomfort and refused medication he was humanly euthanatized.

On postmortem severe cartilage degeneration of multiple joints, stomach ulceration, fat necrosis, and pancreatic changes were found. To the authors knowledge this is the first time that diabetes mellitus was diagnosed in an elephant.

Case Report

A 50-year-old male Asian elephant (Elaphus maximus) “Murugan” weighing approximately 5000 kg, was suffering from (suspected) chronic joint disease and reoccurring bouts of colic. In particular the right elbow and both carpal joints were affected. Murugan showed different degrees of lameness over the years and occasionally snapping sounds were heard from the joints. He sometimes seemed to have difficulty in bearing weight on his right front leg and “snapped through” his carpal joint. The elephant needed regular hoof and nail trimming via “Target Training” (under the guidance of Mr. Alan Roocroft, Elephant Business, Ramona, CA). As part of the treatment, he was made to stand in a plastic tub with lukewarm water and soap to help to soften the toe abscesses. Particular digits III and IV of the right front foot needed repetitive treatment due to necrotic laminitis with resulted in entire nails being removed. This treatment has been described by numerous authors.^1,3

When Murugan showed discomfort and pain he orally medicated with phenylbutazone powder (Equipalazone Powder®, Arnolds Veterinary Products Ltd, Shrewsbury, Shropshire, SY1 3TB UK). Starting dose 4 mg/kg BW twice daily (20 sachets BID) for 2 days, 2 mg/kg twice daily (10 sachets BID) for 2 days and thereafter 1 mg/kg (five sachets) SID After 1 week the dose was reduced to 1 mg/kg on alternate days as long as needed. The drugs were administered in bread mixed with beet or cane sugar syrup. The horse dose was used and extrapolated for the animal’s weight.⁷

In July 2002 Murugan was examined using an “infra-red thermograph” camera (Dr. Sabine Hilsberg, Frankfurt Zoo, Germany). The thermographs confirmed the suspicion of joint disease by showing intensive “hot spots” in the carpal and right elbow joint.⁵

Apart from regular recurring lameness, Murugan had bouts of vague signs of colic. These signs were thought to be caused by constipation of the colon and treated successfully with laxatives, liquid paraffin (Eurovet BV, Bladel, the Netherlands), dietary measures and a combination of metamizol and scopolamine injections (Buscopan Compositum®, Boehringer Ingelheim BV, Alkmaar, the Netherlands; containing 500 mg/ml metamizole-sodium and 4 mg/ml butyl-scopolamine). The recommended dose was used and extrapolated to the elephants’ weight thus receiving 250 ml in total (125 g metamizol and 2 g scopolamine).

Late Summer of 2002–Spring 2003

Murugan appeared to have increasing joint pain. The oral dose of phenylbutazone was raised again (with increasing risk of stomach mucosa ulceration, as seen in the horse²). But other oral NSAIDS like vedaprofen (Quadrisol, 100 mg/ml oral paste, Intervet, Boxmeer, the Netherlands) was refused by the animal.

X-rays were taken from his toes (with the help of Dr. Willem Schaftenaar of Blijdorp Zoo, Rotterdam) following the technique as described by Gace⁴ did not reveal involvement of periost or articular surfaces of phalange. Carpal joint dimensions prohibited X-ray assessment. Murugan developed severe ventral and preputial edema, which responded well to oral hydrochlorothiazide and dexamethasone treatment (Diurizone® 20 gram powder, Vétoquinol S.A., 70204 Lure, Cedex, France, 25 mg dexamethasone and 7.5 g hydrochlorothiazide per 100 g powder). Starting dose 400 g on D1, followed by 200 g on D2–4 and slowly cut back to 50 g every second day. However, as soon as treatment was stopped the edema returned. The cause of the ventral and preputial edema could not be established by physical and/or laboratory analysis.

Therapy was then changed to 30 g oral furosemide SID (Sigma—Aldrich Chemie BV, Zwijndrecht, the Netherlands) and 140 mg dexamethasone injection (Voreen®, Boehringer Ingelheim BV, Alkmaar, the Netherlands), followed by 2.5 g SID oral encapsulated prednisolone (Alfasan Nederland BV, Woerden, the Netherlands, 150 mg per capsule). After 4 days the dose was halved and later administered on alternate days.

Blood work revealed the following abnormalities (values were compared with the ISIS data⁶ for Indian elephants) (Table 1). As from March 2003 urine analysis showed high and rising glucose levels and some protein. Repeated blood analysis shown in Table 2. As a result, the dexamethasone was stopped. However, glucosuria remained unchanged (>100 mg/ml).

Table 1. Results of blood analysis from November 2002

Table 2. Results of blood analysis from March 2003

Spring 2003

Physical symptoms of debilitation and discomfort got worse. Murugan suffered from pain despite the NSAID treatment (butazolidine) and difficult to train because of “introvert” behavior. He refused his medication more and more.

By the end of May his stool turned black (melena) and were sometimes covered with frank blood. Stomach or duodenal ulceration was feared. In addition, snapping sounds in the joints increased and the elephant had more and more difficulty to stand on his right front leg.

Due to the severity of the signs and the fatal prognosis Murugan was humanly euthanatized on the 4th of June 2003, using 6 ml LA-Immobilon® (2.45 mg etorphine and 10 mg/ml acepromazine, Veticore, Marlow, Bucks, SL7 1FJ, UK) and 750 ml of pentobarbital (Euthasate®, 200 mg/ml, Sanofi Santé BV, Maassluis, the Netherlands).

Since Murugan—a wild caught bull—had no offspring, an effort was made to obtain semen by electro-ejaculation carried out by Drs. Hildebrandt and Göritz, of the IZW in Berlin, Germany. However, no live sperm could be collected.

Postmortem Findings

Good bodily condition. No molars found in the mandible. Severe fat necrosis in entire abdomen, associated with pancreatitis. Severe stomach ulcer and petechia in mucosa associated with blood loss. Swollen liver and spleen (from euthanasia solution?), enlarged right ventricle of the heart with aortic stenosis and “jet lesions” in aortic wall. Endocardiosis of left AV-valve. The pancreas felt too firm. The testicles were small and atrophied.

The articular surface of the right carpal joint was almost entirely gone with a 2×3×3 cm free floating cartilage body. Arthritis in left carpal joint, right elbow and between cervical vertebra C1 and C2 was also diagnosed.

Histology

Generalized chronic arthritis with severe cartilage lesions in multiple joints. Generalized fat necrosis. Pancreas: very irregular, sometimes very small islets of Langerhans, some vacuolization of the endocrine cells of islets and of the epithelium of the smaller ducts. A layer of connective tissue surrounds some of the islets.

Irregular glomeruli with interstitial inflammatory reaction in both kidneys. Testicles: brown pigment in interstitial macrophages and sperm production in seminiferi tubuli. Liver: iron pigment in Kupffer cells and some in hepatocytes. Multifocal infiltration of round nuclear cells in vessel walls periportally with some amyloid disposition. Multiple ulcers and mucosal erosions in stomach. Focal necrosis of some heart muscle fibres. Aorta; increased number of vessels and plamacellular infiltrates in intima.

Blood analysis carried out on samples taken just before the euthanasia (Table 3).

Table 3. Results of blood analysis from June 2003 just prior to euthanasia

Conclusion

The fact that only very small remnants of the cheek teeth were found makes difficult food uptake likely.

Murugan suffered from severe arthritis of multiple joints as seen commonly in old elephants.^1,3 Mainly the left and right carpal joints (front feet) were affected as well as arthritis of two cervical inter-vertebral joints. His colossal head and tusks may have contributed to this phenomenon. Because of the continuous analgesic therapy stomach erosion and ulceration occurred resulting in abdominal pain, inappatence, and melena. As seen more often⁸ in elephants the ventral edema could not be explained.

Pancreatitis (very painful on its own in humans) could have contributed to the bouts of colic, leading to fat necrosis and diabetes mellitus type I (pancreatic insufficiency). This explains the polyuria-polydipsia as was seen in the animal. diabetes mellitus has (to the best of the authors’ knowledge) never been described before in elephants.

Literature Cited

1.  Csuti, B, Sargent, E.L. and Bechert, U.S. Eds. 2001. The Elephant’s Foot. Prevention and Care of Foot Conditions in Captive Asian and African Elephants.

2.  Davidson, G and DC Plumb. 2003 Veterinary Drug Handbook. Iowa State University, Ames, Iowa USA. pp 116–117.

3.  Fowler, M. 1993 Foot care in elephants. In: Zoo and Wildlife Medicine, Current Therapy 3. Ed. M.E. Fowler. W.B. Saunders Company, Philadelphia. pp 448–453.

4.  Gace L.J. 1999. Radiographic Techniques for the elephant foot and carpus. In Zoo & Wildlife Medicine, Current Therapy 4. Ed. M.E. Fowler and R.E. Miller. W.B. Saunders Company, Philadelphia. pp 517–520.

5.  Hilsberg, S. 2002. Clinical application of infrared-thermography in inflammation diagnosis in mega-herbivores. Proceedings of the Joint EAZWW and EWDA Conference. Heidelberg Germany.

6.  ISIS. 1999. The electronic database for physiological data reference values. Ed. J.A. Teare.

7.  Mortenson, J. 1998. Determining dosages for anti-inflammatory agents in elephants. Proceedings AAZV and AAWV Joint Conference. pp. 477–479.

8.  Schmitt, D.L 2003. Proboscidea (elephants). In: Zoo and Wildlife Medicine, 5th edition. Eds ME Fowler and RE Miller. Saunders, St. Louis. p. 548.