Haemolytic anaemia and bilateral uveitis associated with leptospirosis in a 6‐year‐old Quarter Horse gelding

Abstract

Summary A 6‐year‐old Quarter Horse gelding was presented for bilateral uveitis resulting in vision loss as well as icterus. Anaemia with autoagglutination was consistent with a presumptive immune‐mediated haemolytic anaemia. Urinary PCR was positive for Leptospira spp. and microscopic agglutination test (MAT) titres were elevated to multiple serovars supportive of a diagnosis of leptospirosis. Treatments included broad spectrum antibiotics and aggressive anti‐inflammatory medications. While the horse was hospitalised, the development of bilateral corneal ulcers precluded the use of topical ophthalmic anti‐inflammatories for a number of days. The corneal ulceration resolved, vision returned in both eyes and the immune‐mediated haemolytic anaemia resolved. After 9 days of hospitalisation, oral minocycline was administered for 2 weeks at home as well as low dose oral flunixin meglumine and topical ophthalmic diclofenac and atropine. This case represents the first published case of haemolytic anaemia associated with leptospirosis in a horse.

Association of acute leptospirosis with systemic disease and uveitis in horses

“…); although cultures of ocular fluids were not done in this report (Delph et al . ), the rapid resolution of the uveitis after treatment suggests that intraocular leptospires were not present in this horse. It would be very important, however, that the horse be monitored for the next 12–18 months to determine if classic ERU will develop.…”

“…In this horse (Delph et al . ), once the IMHA was effectively treated, the uveitis appeared to resolve rapidly even prior to specific treatment for leptospirosis (5 days after admission), further providing evidence of the association between the IMHA and acute uveitis.…”

“…The acute uveitis observed in this horse (Delph et al . ) was probably associated directly with haemolysis of the presumed IMHA. The IMHA‐associated bleeding, endothelial disease, and breakdown of the blood ocular barrier likely culminated in the development of bilateral active uveitis.…”

“…The horse in this report (Delph et al . ) had severe bilateral uveitis, but by definition, it did not have ERU; but instead it had developed acute onset uveitis of only 5 days' duration. It is important to understand that the uveitis observed in this horse may or may not be directly associated with leptospirosis.…”

“…The horse of this study (Delph et al . ) had instead an acute uveitis that probably did not have sufficient time to develop immune‐mediated disease. Some studies have reported a positive culture of leptospiral organisms from equine eyes with acute uveitis (Polle et al .…”