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Use of deferiprone for the treatment of hepatic iron storage disease in three hornbills

Peter SandmeierKleintier- und Vogelpraxis, Tafernstrasse 11b, 5405 Baden-Dättwil, Switzerland

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Marcus ClaussClinic for Zoo Animals, Exotic Pets and Wildlife, Vetsuisse Faculty, University of Zurich, 8057 Zurich, Switzerland

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Olivio F. DonatiDepartment of Medical Radiology, Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, 8091 Zurich, Switzerland

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Koen ChiersLaboratory of Veterinary Pathology, Faculty of Veterinary Medicine, Ghent University, 9000 Ghent, Belgium

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Ellen KienzleInstitute of Animal Physiology, Physiological Chemistry and Animal Nutrition, Ludwig-Maximilians-University, 80539 Munich, Germany.

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Abstract

Case Description—3 hornbills (2 Papua hornbills [Aceros plicatus] and 1 longtailed hornbill [Tockus albocristatus]) were evaluated because of general listlessness and loss of feather glossiness.

Clinical Findings—Because hepatic iron storage disease was suspected, liver biopsy was performed and formalin-fixed liver samples were submitted for histologic examination and quantitative image analysis (QIA). Additional frozen liver samples were submitted for chemical analysis. Birds also underwent magnetic resonance imaging (MRI) under general anesthesia for noninvasive measurement of liver iron content. Serum biochemical analysis and analysis of feed were also performed. Results of diagnostic testing indicated that all 3 hornbills were affected with hepatic iron storage disease.

Treatment and Outcome—The iron chelator deferiprone was administered (75 mg/kg [34.1 mg/lb], PO, once daily for 90 days). During the treatment period, liver biopsy samples were obtained at regular intervals for QIA and chemical analysis of the liver iron content and follow-up MRI was performed. In all 3 hornbills, a rapid and large decrease in liver iron content was observed. All 3 methods for quantifying the liver iron content were able to verify the decrease in liver iron content.

Clinical Relevance—Orally administered deferiprone was found to effectively reduce the liver iron content in these 3 hornbills with iron storage disease. All 3 methods used to monitor the liver iron content (QIA, chemical analysis of liver biopsy samples, and MRI) had similar results, indicating that all of these methods should be considered for the diagnosis of iron storage disease and monitoring of liver iron content during treatment.

Abstract

Case Description—3 hornbills (2 Papua hornbills [Aceros plicatus] and 1 longtailed hornbill [Tockus albocristatus]) were evaluated because of general listlessness and loss of feather glossiness.

Clinical Findings—Because hepatic iron storage disease was suspected, liver biopsy was performed and formalin-fixed liver samples were submitted for histologic examination and quantitative image analysis (QIA). Additional frozen liver samples were submitted for chemical analysis. Birds also underwent magnetic resonance imaging (MRI) under general anesthesia for noninvasive measurement of liver iron content. Serum biochemical analysis and analysis of feed were also performed. Results of diagnostic testing indicated that all 3 hornbills were affected with hepatic iron storage disease.

Treatment and Outcome—The iron chelator deferiprone was administered (75 mg/kg [34.1 mg/lb], PO, once daily for 90 days). During the treatment period, liver biopsy samples were obtained at regular intervals for QIA and chemical analysis of the liver iron content and follow-up MRI was performed. In all 3 hornbills, a rapid and large decrease in liver iron content was observed. All 3 methods for quantifying the liver iron content were able to verify the decrease in liver iron content.

Clinical Relevance—Orally administered deferiprone was found to effectively reduce the liver iron content in these 3 hornbills with iron storage disease. All 3 methods used to monitor the liver iron content (QIA, chemical analysis of liver biopsy samples, and MRI) had similar results, indicating that all of these methods should be considered for the diagnosis of iron storage disease and monitoring of liver iron content during treatment.

Contributor Notes

Supported in part by the Swiss Association of Wild, Zoo, and Pet Animal Medicine (SVWZH).

The authors thank Werner Hesselbach for assistance with laboratory testing, Anja Struwe and Irini Kakales for performing the magnetic resonance imaging studies, D. Ameye, I. De Bleeker, S. Loomans, and C. Puttevils for technical assistance, and Klaus Kälin for providing technical support.

Address correspondence to Dr. Sandmeier (sandmeier@kleintierpraxis.ch).