Cerebral haemorrhage in a pregnant Standardbred mare with Evan's syndrome

A 3‐year‐old pregnant Standardbred mare was treated at the University of Helsinki Equine Teaching Hospital for severe idiopathic immune‐mediated thrombocytopenia and haemolytic anaemia (Evan's syndrome). Despite initial improvement with supportive care and immunosuppressive doses of corticosteroids and azathioprine, the mare died from a fatal cerebral haemorrhage on Day 21 of treatment.     

Renal failure in a pregnant mare

Although chronic renal disease is uncommon in horses, guidelines for management of the broodmare with kidney disease are needed to ensure successful foaling. Herein, we present a case report of a broodmare with chronic renal disease that produced a live foal, and parturition was predicted by monitoring pH and electrolytes in the milk. A 15-year-old pregnant mare presented with a history of poor body condition and weight loss despite an excellent appetite. At presentation, the mare was bright, alert and responsive, with severe pitting ventral oedema and vital parameters within normal limits. Plasma biochemistry revealed azotaemia, hypercalcaemia and hypophosphataemia. Based on clinical ultrasonographic and biochemical parameters, the mare was diagnosed with renal failure. Pregnancy was assessed by transabdominal ultrasound, and the fetal parameters were within normal limits; however, an increased combined thickness of the uterus and placenta and oedematous fetal membranes were found. Monitoring of mammary secretions accurately predicted the onset of foaling at 326 days of gestation. A healthy filly was delivered, and the fetal membranes were passed in a timely manner without complications. Physical examination and haematological parameters were within the normal limits for a neonate foal, except for a mild elevation in blood urea nitrogen. Two weeks later, the mare was subjected to euthanasia due to worsening of her condition. At necropsy and on histopathological examination, the findings were consistent with chronic renal disease. This case demonstrates that a pregnant horse with chronic renal disease can be managed with supportive care and produce a viable foal. Fetal well-being and mare’s prefoaling milk electrolytes were similar to parameters measured in healthy pregnant mares, suggesting that the feto-placental unit may be spared of the dam’s systemic disease. Prepartum physiological changes in the milk may be unaltered with concurrent maternal renal disease and still be useful for foaling prediction.     

Haemoperitoneum in a pregnant mare with an ovarian haematoma

Haemoperitoneum is a rarely reported but life‐threatening complication of a multitude of disease processes that can affect horses. This report describes an unusual case of haemoperitoneum in a pregnant mare attributed to a unilateral ovarian haematoma during early gestation. The mare was treated with supportive care and discharged 8 days after initial presentation. Following discharge, the mare maintained her pregnancy to term and delivered a live colt at 321 days of gestation.     

A case of verminous mastitis in a mare

This report describes bilateral mammary gland infection with a previously unidentified Cephalobus species of nematode. Only one previous case of verminous mastitis due to a Cephalobus species has been reported, pre-dating the widespread use of molecular diagnostics. This report describes the case presentation and management, as well as the morphological and molecular methods of nematode identification.     

Successful laparoscopic surgery for a uterine leiomyoma in a mare

Leiomyomas are the most common of uterine tumours in mares but large tumours are rare. A case with a 15 cm uterine leiomyoma diagnosed by rectal palpation and ultrasound examinations with apparent adverse effects on fertility is reported. Management of the case was by hand assisted laparoscopic tumour removal and unilateral ovariectomy. Complications included post operative pain, tachycardia and wound infection. The mare was confirmed to be in foal after her first cover post surgery.     

Hepatic encephalopathy in a pregnant mare: identification of histopathological changes in the brain of a mare and fetus

An 11-year-old Thoroughbred broodmare was evaluated for suspected hepatic dysfunction. Clinical signs of hepatic encephalopathy were evident at admission. Hepatic ultrasonographic evaluation revealed an increase in hepatic size, rounded borders and normal echogenicity. There was no evidence of cholelithiasis or bile duct distention. Increased activity of hepatic enzymes, increased bile acid and bilirubin concentration and an increased ammonia concentration were supportive of a diagnosis of hepatic disease and hepatic encephalopathy. Histopathological evaluation of a liver biopsy specimen was consistent with chronic active hepatitis. The mare was treated with intravenous fluids and antimicrobials, pentoxyfilline, branched-chain amino acids and dietary manipulation. Clinical improvement was observed initially; however, 3 weeks later, deterioration in the mare's condition necessitated euthanasia. Pathological lesions at necropsy were restricted to the liver and brain. The liver was diffusely firm with a prominent reticular pattern on the cut surface. A large choledocholith was present in the main bile duct of the left liver lobe. Histopathological examination of the liver revealed severe fibrosis, with hyperplastic bile ducts and mononuclear and neutrophilic inflammation. Pathological changes consistent with hepatic encephalopathy, (Alzheimer type II cells), were evident in the cerebrum of both the mare and the fetus.     

Granulosa cell tumour: An interesting case in a pregnant mare

This report describes the successful management of a pregnant 14‐year‐old seven‐eighths Thoroughbred mare with an ovarian granulosa cell tumour. The mare initially presented with unilateral ovarian enlargement whilst being managed for artificial insemination, demonstrating normal ovarian function with ovulation from the contralateral ovary leading to conception. The mare subsequently re‐presented with stallion‐like behaviour at 3.5 months gestation and ovarian suppression was evident. The mare maintained her pregnancy and delivered a live colt foal at term. Ovariectomy was performed 3 months post foaling and the mare regained cyclic activity 9 months post surgery. The mare then conceived and became pregnant once more. The diagnostic and therapeutic challenges during pregnancy are discussed.     

Successful treatment of Sarcoptes scabiei in a 33‐year‐old pony with underlying pituitary pars intermedia dysfunction

A pony presented with a severe, chronic dermatitis around the ears, neck and trunk of the body, hind quarters and ventral abdomen. The pony was intensely pruritic as was an in‐contact pony and both owners. A superficial skin scraping demonstrated multiple living mites, identified as Sarcoptes scabiei. Equine pituitary pars intermedia dysfunction (PPID) was diagnosed as an underlying, potentially immunosuppressive disorder. The pony was treated for Sacroptes scabiei as well as PPID and is doing well 2 months after initial presentation.     

Premature luteal regression in a pregnant mare and subsequent pregnancy maintenance with the use of oral altrenogest

Premature luteal demise or luteal insufficiency is not well characterised as a cause of pregnancy loss in domestic species, including horses. In this report, a mare inseminated with cooled‐transported semen at our facility returned for a routine pregnancy diagnosis at 15 days post ovulation. Ultrasonography per rectum revealed endometrial oedema and the absence of visual indication of a corpus luteum on either ovary. Nonetheless, an embryonic vesicle small for the gestational age was identified. Daily oral altrenogest treatment was implemented immediately. Serum progesterone concentration was 0.67 ng/ml, which is below the threshold considered adequate for pregnancy maintenance in the mare. Examinations were repeated at 17, 25, 30, 39, 49, 72 and 120 days post ovulation. At 25 days post ovulation the embryonic vesicle presented normal development for the gestational age. In addition, sequential blood samples were collected to measure progesterone, equine chorionic gonadotrophin and oestrone sulphate concentrations. Although progesterone concentration did not exceed 2 ng/ml until 72 days post ovulation, all other results were unremarkable and a healthy filly was born uneventfully at 344 days post ovulation.     

Successful treatment of cryptococcal pneumonia in a pony mare

A 20-year-old Welsh Mountain Pony (212 kg) mare was initially presented for a chronic cough, fever, weight loss and low grade abdominal pain. She later developed dyspnoea, tachypnoea and exercise intolerance. The presence of multiple masses (up to 17 cm diameter) in the pulmonary parenchyma was established using lateral thoracic radiography and transthoracic ultrasonography. Encapsulated, budding yeasts were observed in smears made from transtracheal washings and needle aspirates of the pulmonary lesions. Cryptococcus gattii (synonym: Cryptococcus neoformans variety gattii; Cryptococcus bacillisporus) was cultured from the transtracheal washings and aspirates of the lung masses. The pony was successfully treated using daily intravenous infusions of amphotericin B (typically 0.5 mg/kg in 1 L 5% dextrose in water over 1 h, following premedication with 50 mg flunixin intravenously) over a 1 month period, until a cumulative dose of 3 g had been administered. Treatment was considered to be successful on the basis of progressive improvement in clinical signs, reduction in the size of pulmonary cryptococcomas, 48 kg weight gain and a reduction in the cryptococcal antigen titre from 4096 to 256, 1 year after cessation of treatment.     

Atrial fibrillation in a pregnant mare: treatment with quinidine sulfate

Atrial fibrillation in a pregnant, lactating, 15-year-old mare nursing a 70-day-old foal was converted to normal sinus rhythm, using quinidine sulfate. The maximum concentration of quinidine was 4.3 mg/L in the mare's milk and was 2.6 mg/L in the mare's serum. Treatment with quinidine did not interrupt the pregnancy. Six months after treatment, the mare developed acute volvulus of the large colon and died. At necropsy, the mare did not have macroscopic or microscopic cardiac lesions. The fetus was macroscopically and histologically normal.     

Guttural pouch empyema caused by Corynebacterium pseudotuberculosis in a pregnant mare

During medical management of mild colic in a 12‐year‐old Quarter Horse, mid‐gestation mare, unilateral purulent nasal discharge from the right nostril was noted. Endoscopic examination revealed guttural pouch empyema. Culture was positive for Corynebacterium pseudotuberculosis and negative for Streptococcus equi ssp. equi. A synergistic haemolysis inhibition titre of 1024 was consistent with C. pseudotuberculosis infection. Treatment included serial lavages and local infusion of antibiotics into the guttural pouches along with a 6‐week course of oral trimethoprim–sulfamethoxazole and rifampicin. Overall, no additional sites of infection were identified and the mare responded well to treatment, delivering a healthy, full‐term foal. This case emphasises that C. pseudotuberculosis, although uncommon, should be considered as a differential for guttural pouch empyema.     

Rostral mandibulectomy for treatment of a sarcoma in a 16-year-old Thoroughbred mare

A 16-year-old Thoroughbred mare presented with a 1-year history of a growing mass on the rostral mandible. Biopsy performed by the referring veterinarian revealed chronic granulating fibrosis and stomatitis. Due to progressive loss of body condition and increasing size, the mare presented to the clinic. Radiographic examination of the mandible revealed osteolytic lesions. Mandibulectomy was performed under general anaesthesia. The horse's demeanour and feed intake improved significantly and the cosmetic outcome was acceptable. Histopathological examination confirmed a sarcoma, most likely a fibrosarcoma.     

Successful treatment of traumatic oesophageal rupture with severe cellulitis in a mare

A five-year-old standardbred mare suffered a cervical oesophageal rupture subsequent to a kick. Marked cellulitis and extensive soft tissue damage resulted. Treatment consisted of creating an oesophageal fistula, local debridement and systemic antibiotics. The mare made a long but successful recovery. Treatment of oesophageal rupture in the horse is discussed.     

Successful treatment of a horse with presumed parasitic encephalitis

Verminous myeloencephalitis is a rare, but predominately fatal, cause of neurological disease in horses. A 6‐year‐old mare was admitted to the Royal Veterinary College Equine Referral Hospital following acute onset of depression, central unilateral blindness and compromised vision in the opposite eye. Based on pronounced eosinophilic inflammation detected in the cerebrospinal fluid (CSF) and diagnostic imaging findings indicating a space‐occupying lesion within the brain, a presumptive diagnosis of aberrant parasitic migration causing parasitic encephalitis was made. Treatment consisted of anti‐inflammatories and high doses of an anthelmintic. The horse's condition improved, the neurological deficits and observed space‐occupying lesion within the brain resolved completely and the mare returned to full work. To the authors’ knowledge, this is the first report describing complete recovery from suspected aberrant parasite migration in the CNS and will hopefully encourage treatment of suspected cases in the future.     

Acupuncture and traditional Chinese veterinary medicine for treatment of a mare with rectal paralysis

An 8‐year‐old Appaloosa mare with rectal paralysis due to a cosmetic ethanol ‘tail block’ was treated with traditional Chinese veterinary medicine treatments including acupuncture and herbal medicine. Her rectal and tail tone gradually improved after the treatment. At 4 months after initial presentation, the mare was able to produce faecal piles on a regular basis, and manual evacuations were no longer needed. Significant improvement was within 30 days of beginning treatment. At 8 months, the owner indicated that the mare had normal defaecation, was able to swish the tail from side to side and lift the tail to urinate, and had no evidence of straining to defaecate or colic.