title: Edema and tetraparesis in a miniature pig after allogeneic hematopoietic cell transplantation.
abstract: A 3-mo-old, 12-kg, intact, miniature pig presented with severe neurologic signs on day 8 after hematopoietic cell transplantation. This pig had received an immunosuppressive regimen before transplantation that included an antiCD3 immunotoxin for T-cell depletion, 100 cGy of total-body  irradiation, and cyclosporine for 45 d. The pig began exhibiting erythematous lesions on posttransplantation day 7. He also demonstrated increased conscious proprioceptive deficits and recumbency but normal mentation. Neurologic signs worsened over several days; the pig became lethargic but  remained afebrile. Conjunctival swelling developed on posttransplantation day 9, which subsequently spread to the animal's head, ears and hocks by day 10. Analgesics were given for pain, and cyclosporine levels were decreased. Despite the measures taken, neurologic signs progressed. Given  the worsening subcutaneous edema and neurologic status, Escherichia coli infection was suspected, and treatment with a third-generation cephalosporin was instituted. The clinical signs resolved within 12 h after the start of antibiotics. 'Shiga-like' toxin from E. coli can cause  peracute toxemia and induce ataxia, paralysis, and recumbency. Other common and pathognomonic findings include periocular edema and variable edema in other subcutaneous regions. A fecal sample demonstrated an overgrowth of gram-negative, lactose-fermenting colonies. On the basis of the clinical  presentation, exclusion of other potential conditions compatible with edema and neurologic diseases, physical exam findings, microbiology and the resolution of signs after therapy, the pig was diagnosed with edema disease.
authors.affiliation: Transplantation Biology Research Center, Massachusetts General Hospital, Boston, USA.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Crepeau
authors.forename: Abraham
authors.initials: A
authors.lastname: Matar
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Spitzer
authors.forename: Simon
authors.initials: S
authors.lastname: Robson
authors.forename: Vimukthi
authors.initials: V
authors.lastname: Pathiraja
authors.forename: David H
authors.initials: DH
authors.lastname: Sachs
authors.forename: Christene A
authors.initials: CA
authors.lastname: Huang
authors.forename: Raimon
authors.initials: R
authors.lastname: Duran-Struuck
mesh_terms: D000818:Animals; D000830:Animals, Laboratory; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016572:Cyclosporine / Q000627:therapeutic use; D004487:Edema / Q000209:etiology / Q000473:pathology / Q000662:veterinary*; D004927:Escherichia coli Infections / Q000150:complications / Q000188:drug therapy / Q000473:pathology / Q000662:veterinary*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D007958:Leukocyte Count / Q000662:veterinary; D008297:Male; D020886:Somatosensory Disorders / Q000209:etiology / Q000473:pathology / Q000662:veterinary*; D013552:Swine; D013553:Swine Diseases / Q000188:drug therapy / Q000382:microbiology* / Q000473:pathology; D013556:Swine, Miniature
chemical_list: D000900:Anti-Bacterial Agents; D016572:Cyclosporine