Systemic Granulomatous Disease in a Hungarian Warmblood Gelding

An 8-year-old Hungarian warmblood gelding used for show jumping was evaluated because of poor performance and chronic weight loss. On admission, oral and gastroesophageal ulcerations and malabsorption were detected. Results of thoracic radiography, ultrasonography, bronchoalveolar lavage cytology, and positive polymerase chain reaction for equine herpesvirus 5 raised the possible diagnosis of equine multinodular pulmonary fibrosis. However, abdominal ultrasonography revealed inhomogeneous spleen with many different sized well-demarcated hypoechoic areas, which suggested further differential diagnoses such as tuberculosis, neoplasias, immune mediated diseases, systemic granulomatous disease (SGD), or toxicoses. The horse was euthanized at the owner's request because of the poor condition and possible grave prognosis. Histopathology findings were characteristic of SGD, which is a rare disorder of horses characterized by skin lesions, weight loss, and granulomatous inflammation of multiple organ systems. The lack of skin lesions in this case is an unusual finding. Systemic granulomatous disease is hypothesized to be induced by multiple conventional antigens that are not cleared from affected tissues. Equine herpesvirus 5 might have triggered the granulomatous reactions in this particular case.     

Lack of Detectable Equine Herpesviruses 1 and 2 in Paraffin-Embedded Specimens of Equine Sarcoidosis

Background: Equine sarcoidosis is a rare, multisystemic, noncaseating, granulomatous and lymphoplasmacytic disease of unknown etiology. A recent report described a horse with granulomatous skin disease displaying histologic, electron microscopic, and polymerase chain reaction (PCR) findings consistent with equine herpesvirus 2 (EHV-2).
Objective: To investigate the presence of EHV-2 and equine herpesvirus 1 (EHV-1) in 8 horses with sarcoidosis.
Animals: Eight horses with sarcoidosis, reported previously.
Methods: Retrospective study. PCR assays of the tissues were performed to detect DNA associated with EHV-1 and EHV-2. For both herpesviruses the target was their respective glycoprotein B gene. Positive controls consisted of DNA from viral cultures of culturettes from naturally occurring respiratory infections of EHV-1 and EHV-2.
Results: The PCR analyses for both equine herpesviruses' DNA were negative in all 8 horses.
Conclusion: The failure to detect DNA from EHV-1 and EHV-2 in paraffin-embedded skin of these 8 horses does not discount EHV-1 or EHV-2 as causing some cases of ES, but lends support to the presumably multifactorial etiologic nature of the disease.     

Equine herpesvirus 2-associated granulomatous dermatitis in a horse

Granulomatous dermatitis in horses has been linked to many etiologies, including various parasites, fungi, and bacteria. Idiopathic forms of granulomatous inflammation-producing diseases, some of which are localized to the skin, also have been reported in horses. Herein we describe a case of recurrent equine granulomatous skin disease characterized by intranuclear viral inclusions within macrophages and giant cells. The histologic changes were primarily noted in the deep dermis and included multifocal to coalescing areas of necrosis marked by histiocytic cell infiltration and presence of giant cells. Electron microscopic examination revealed intranuclear and intracytoplasmic viral particles consistent with herpesvirus. Sequence results of the polymerase chain reaction product were consistent with equine herpesvirus 2, adding another possible etiology to the list of differentials in cases of equine granulomatous skin disease.     

Role of the chemokine eotaxin in the pathogenesis of equine sweet itch

The chemokine eotaxin is involved in the recruitment of eosinophils and T helper 2 lymphocytes in human allergic diseases, and drugs that block its activity, including eotaxin receptor (CCR3) antagonists, are being developed. The authors have recently cloned the horse ortholog of eotaxin and shown that it can induce equine eosinophil migration and activation in vitro. Moreover, eotaxin mRNA expression was upregulated in cultured horse dermal fibroblasts exposed to equine interleukin-4, suggesting a possible source of this eosinophil chemoattractant in equine skin. The results of this study show that eotaxin and monocyte chemoattractant protein (MCP) 1, but not MCP-2 or MCP-4, mRNA expression is upregulated in skin biopsies of sweet itch lesions when eosinophils are present, when compared with clinically normal skin from the same ponies.     

Dexamethasone for treatment of multisystemic eosinophilic epitheliotropic disease in a horse

A 4-year-old Paint mare was examined because of respiratory tract infection, dermatitis, and weight loss of 2 months' duration. Initial examination revealed generalized pruritic dermatitis, ocular and nasal discharges, and stranguria. Laboratory abnormalities included leukopenia and hypoalbuminemia. Further examination of the respiratory tract revealed grade III of IV pharyngitis and pyogranulomatous pneumonia. Endoscopic examination of the bladder revealed a prolific mass at the junction of the bladder and urethra. Hypoproteinemia was suspected to be caused by protein-losing enteropathy. On histologic examination, skin, rectal, pharyngeal, and urethral biopsy specimens were characterized by infiltration of eosinophils and lymphocytes, and a diagnosis of multisystemic eosinophilic epitheliotropic disease was made. The horse improved following treatment with dexamethasone, trimethoprim-sulfamethoxazole, and an antihistamine and was discharged after 19 days of hospitalization. Treatment with dexamethasone was continued for 4 weeks after hospitalization but was then discontinued. Eight months after discharge, the horse was performing as a pleasure horse and did not require any medical treatment. Multisystemic eosinophilic epitheliotropic disease is typically associated with a poor prognosis in horses. The dermatitis, protein-losing enteropathy, and lower respiratory tract disease in this horse were consistent with previous reports; however, pharyngitis and urethritis have not, to our knowledge, been previously reported in horses with this disease.     

Treatment of mycotic tracheitis in a horse with fluconazole and systemic iodine

Fungal infections of the equine trachea have been rarely reported. This case report describes the successful treatment of a mare with fungal infection of the trachea that had severe diffuse granulomatous thickening, erosions and haemorrhage of the proximal half of the trachea. The horse was treated with oral fluconazole and systemic iodine therapy. Serial endoscopic examinations confirmed rapid resolution of the condition.     

Generalized sarcoidosis in two horses

Equine sarcoidosis is a rare disorder usually characterized by exfoliative dermatitis, moderate to severe wasting, and sarcoidal granulomatous inflammation of multiple organ systems. It has an unknown aetiopathogenesis. The condition is not related to equine sarcoid. This case report describes generalized cutaneous and systemic sarcoidosis in an 11-year-old Trakehner mare (case A) and in a 7-year-old Dutch Warmblood gelding (case B). Case A was presented with cutaneous sarcoidosis on the head and body and was diagnosed on the basis of histological examination of skin. Case B presented with multiple subcutaneous nodules (2-15 cm in diameter) and the diagnosis was established at postmortem examination. Both horses showed distinctive histology of the skin with extensive lymphohistiocytic infiltration and Langhans-type multinucleated giant cells. Haematology and biochemistry revealed a normal total white blood cell count with a right shift in both horses. Case B was anaemic and had a slightly elevated total protein concentration with hyperglobulinaemia. Both horses were unresponsive to corticosteroids and were euthanized.     

Multinodular Malignant Cutaneous Mast Cell Tumor in a Horse With Generalized Pruritus and Reactive Fibrosis: A Case Report

Mast cell tumor (MCT) has long been considered as an uncommon neoplasm in horses. Cytological and behavioral evidence of its malignancy is usually lacking, and only a few reports have described MCT displaying malignant behavior. An 18-year-old Friesian stallion presented with a one-year history of intermittent and progressive skin lesions on the left forelimb associated with intense, generalized pruritus and apathy temporarily responsive to glucocorticoids and antibiotics. The horse was alert and responsive with poor body condition and marked generalized pruritus. The left forelimb was markedly enlarged and surrounded by numerous firm 2- to 20-cm masses that were ulcerated and focally necrotic. A 7-cm round firm mass was observed on the left dorsal neck. Dermatological examination revealed generalized moth-eaten alopecia and scaling with erosions and ulcers secondary to pruritus. A direct skin smear from the affected leg showed severe eosinophilic inflammation and neutrophilic inflammation with pleomorphic bacteria. Histopathology of the skin and biopsies of the underlying tissues revealed an abundant population of atypical mast cells consistent with a malignant MCT. The horse was euthanized and necropsy revealed a marked fibrous reaction on longitudinal sections of the affected limb, and the tumor could be detected on only a few histological slides. Diagnosis of equine MCT can be challenging because of the massive accompanying fibrous reaction. Mast cell tumor should be suspected in the presence of eosinophilic infiltration of the affected tissue and in cases of generalized pruritus not attributable to other causes.     

Immunologic diseases

Selected equine cutaneous diseases for which there is strong evidence of an immunological aetiology are discussed in this section. The reactive disorders of urticaria, Culicoides hypersensitivity, erythema multiforme, drug eruptions and systemic granulomatous disease are included. The autoimmune diseases of the horse with cutaneous manifestations (pemphigus foliaceus, pemphigus vulgaris, bullous pemphigoid and cutaneous lupus erythematosus) are discussed. The clinical signs and diagnostic features of these immunologically induced equine dermatoses are defined, and the challenges in making a definitive diagnosis and managing the clinical signs are confirmed.     

Critical Evaluation of Whole-Body Cryostimulation Protocol in Race Horses

Cold therapy is commonly used to relieve pain and inflammation and to aid in muscle recovery after exercise in human medicine. A number of applications have also been observed in veterinary practice. In this article, a critical evaluation of equine protocol applied with a new commercial concept of equine whole-body cryostimulation (WBC) was made. With this new concept of WBC, the protocol usually utilized for relieving pain and discomfort in humans has been extended to horses. The investigations described herein focus on the reduction of horse skin temperature when applying human WBC protocols. Based on infrared thermography measurements, results show that exposing a horse for 3 minutes to a temperature of −140°C, which are conventional parameters used for humans, does not induce sufficient skin thermal gradients in horses. Consequently, beneficial cold reflexes such as vasomotor, neuroconduction, and biochemical reactions cannot be triggered. Further investigations should therefore be carried out to design an adequate protocol specifically aimed at horses.     

Equine phacoclastic uveitis: the clinical manifestations, light microscopic findings, and therapy of 7 cases

This retrospective clinical study describes the clinical manifestations, light microscopic findings, and diagnosis and treatment of acute and chronic lens rupture in the horse. Rupture of the lens capsule in the horse usually results in a chronic, blinding inflammation (phacoclastic uveitis) unless prompt surgical and medical therapies are implemented. The clinical manifestations of acute lens capsule rupture included: cataract; intralenticular displacement of iridal pigment; lens cortical fragments attached to the perforated lens capsule, iris, and corneal endothelium; miosis; aqueous flare; and usually a corneal or scleral perforation with ulceration or focal full thickness corneal edema and scarring. The clinical signs of chronic phacoclastic uveitis include blindness, phthisis bulbi, and generalized corneal opacification related to scarring, vascularization, pigmentation, and edema. In one horse, acute phacoclastic uveitis was successfully treated with phacoemulsification to remove the ruptured lens and medical therapy to control the accompanying inflammation. The affected eyes of the horses with chronic phacoclastic uveitis were enucleated because of persistent clinical signs of nonulcerative keratitis and uveitis, despite long-term medical management. The clinical manifestations and lack of improvement with medical therapy are similar in the horse, dog, cat, and rabbit. However, the histologic findings in equine phacoclastic uveitis differ significantly from those in the dog, and rabbit.     

Interstitial brachytherapy in the management of haemangiosarcoma of the rostrum of the horse: Case report and review of the literature

Sarcomas arising in the equine species are rare tumours, and treatment is generally surgical. Radiotherapy has been used in the management of malignancies of large animals; however, conventional external radiotherapy delivery is difficult. Interstitial brachytherapy has been used in the management of human sarcomas with reasonable success, although equine experience is minimal. We report a case of equine haemangiosarcoma treated with brachytherapy demonstrating the feasibility of the procedure and the highly malignant natural history of haemangiosarcoma. An 8‐year‐old American Saddlebred gelding presented for evaluation of a soft tissue mass on the forehead which had been present for at least 6 months. Initial surgical attempts at management were unsuccessful; therefore a radiation oncologist specialising in brachytherapy was consulted. The radiation oncologist and veterinary surgeon performed an interstitial implant of the tumour mass on the rostrum of the horse under general anaesthesia. The procedure was well tolerated by the horse. The tumour demonstrated immediate response and was noted to have completely regressed within 6 weeks of the implant removal. Unfortunately, the horse developed widespread metastatic disease and required euthanasia. At the time of necropsy, no visible tumour was identified at the implant site. Interstitial brachytherapy is feasible in soft tissue sarcomas of the horse; however, supportive demands are great with this procedure and we recommend it only be done at large speciality centres.     

Generalised granulomatous disease in a horse

A 6-year-old gelding was referred with a 3-month history of recurrent fever, inappetance, lethargy and weight loss. On clinical examination major findings were depression, thin condition, thrombophlebitis, nodules on the scrotal skin, leukocytosis, hyperfibrinogenaemia and hyperglobulinaemia. Pleural fluid and areas of lung consolidation were seen on ultrasonographic examination of the thorax. A diagnosis of chronic respiratory disease was made. Initially there was a response to antibiotic therapy but the horse was presented 3 months later with continued weight loss, recurrent fever and multifocal skin lesions, characterised by scales, crusts and nodules, affecting the nasal bridge, jugular grooves, ventral neck, withers, scrotum, prepuce, and medial gaskins. Histological evaluation of skin biopsies indicated a granulomatous reaction. On ultrasonographic examination of the thorax multiple hypoechoic lesions consistent with granulomas were seen in both lungs. A diagnosis of generalised granulomatous disease was made. The horse was euthanased at the owner's request. On necropsy examination the main findings were multiple nodules of fibrotic granulomatous inflammation in the lung, heart, liver, gastrointestinal tract and mesenteric lymph nodes, supporting the diagnosis of generalised granulomatous disease.     

Encephalitozoon cuniculi–Associated Equine Encephalitis: A Case Report

A case of encephalitis of unknown origin in the horse was investigated. Postmortem examination findings revealed a nonsuppurative granulomatous meningoencephalitis in the right hemisphere of the cerebral cortex. Testing for West Nile virus, equine herpes virus, equine infectious anemia, Toxoplasma gondii, Neospora caninum, and Sarcocystis neurona were negative. The horse had a titer for Encephalitozoon cuniculi, and sections from the affected area of the brain tested positive for the organism using both polymerase chain reaction (PCR) and immunohistochemistry. Amplicons generated using PCR were sequenced, and E. cuniculi genotype II was identified. This is the first case of E. cuniculi genotype II associated with encephalitis in the horse.     

Preliminary Notes on Equine Tissue Transglutaminase Serology and A Case of Equine Gluten-Sensitive Enteropathy and Dermatitis in an 11-Year-Old Dutch Warmblood Horse

It has been suggested that gluten may play a role in equine inflammatory small bowel disease (ISBD). Previous work showed an association between equine gluten-sensitive enteropathy and IgA antibodies to tissue transglutaminase (TGA) in serum. The purpose of this study is to investigate the prevalence of IgA antibodies to TGA in a group of healthy non–gluten-free sport ponies and to present a case of tentative gluten-sensitive enteropathy and dermatitis in a horse. Blood samples were obtained from 40 healthy jumping ponies. The ponies comprised 12 mares, 8 stallions, and 20 geldings with an average age of 9.0 ± 3.8 years (±SD; range 3–19 years). Sera were tested for IgA antibodies against human recombinant TGA. Significance (P < .05) of the correlation between TGA titer and age in these ponies was assessed using Pearson test (two tailed). In addition, to further illustrate tentative equine gluten-sensitive enteropathy and dermatitis, the clinical course in an 11-year-old Dutch Warmblood sport horse gelding has been described. The average TGA titer was 21.4 ± 13.6 AU/mL (range 2–65 AU/mL). There was a significant (P = .013) correlation (r = 0.389) between age and TGA titer in ponies. One of the 40 ponies (2.5%) showed an elevated TGA titer. An elevated TGA titer decreased after a gluten-free ration for 3 months in an 11-year-old Warmblood gelding with a tentative diagnosis of ISBD associated with full remission of the generalized skin reaction. To our best knowledge, this is the first study assessing TGA antibodies in sera from healthy non–gluten-free ponies and showing a correlation with age. The presented case could be the first one of a horse with a tentative diagnosis of gluten-sensitive enteropathy combined with dermatitis. Given the reported findings, this study warrants further investigations into gluten-sensitive enteropathy and dermatitis in individual horses affected with ISBD.     

Cellular heterogeneity in cathepsin D distribution in equine articular cartilage

The distribution of cathepsin D in normal equine growth cartilage has been examined immunocytochemically using an antiserum raised against human cathepsin D. The cross-reactivity and specificity of the antiserum for equine cathepsin D was confirmed, and its lysosomal localisation was demonstrated in horse skin fibroblasts by confocal scanning microscopy. Cultured horse chondrocytes were heterogenous in their expression of cathepsin D. Heterogeneity of distribution of the enzyme was also seen in chondrocytes in cartilage from different anatomical sites. A high level of cathepsin D was observed in the deep layer of cartilage from the lateral trochlear ridge of the distal femur. Cathepsin D was absent in the hypertrophic zone of the distal radial growth plate.     

Interstate Equine Semen and Embryo Shipment Regulations in the United States and Their Implications on Control of Disease Transmission

Outbreaks of both equine viral arteritis and contagious equine metritis (CEM) in the United States have occurred in recent years. Shipped semen has been implicated in disease transmission and rapid spread. A survey was performed of state regulations regarding testing for equine arteritis virus (EAV) and CEM before interstate semen or embryo shipment. Results demonstrated lack of any requirements in 31 states. Four states had regulations regarding EAV; 17 required a Certificate of Veterinary Inspection (CVI) to accompany a semen or embryo shipment. Ten states required a negative equine infectious anemia test, primarily as a requirement of a CVI versus because of risk of dissemination of disease. No states required CEM testing. A comparison of state department of agriculture or veterinary medical association Web sites and direct communication with state veterinarians or their offices demonstrated contradictory information in six states. The lack of uniform regulations concerning CEM and EAV testing for shipped semen and embryos, and the threat they pose to the equine breeding industry and horse health, should be alarming to veterinarians and horse owners. Routine testing of animals before shipment of semen or embryos and veterinary involvement in collection and breeding activities are appropriate and necessary to help prevent future outbreaks and protect equine health.