A 4-week-old female Caspian filly was examined by Equine Field Services (EFS) at the Virginia-Maryland Regional College of Veterinary Medicine for a 1-week history of bilateral mucopurulent nasal discharge and stertorous breathing. The filly had been bright with a good appetite and was not observed coughing. The owner reported a normal foaling, and the filly had risen and suckled fairly quickly after birth, but the foal's immunoglobulin G (IgG) status was unknown and the mare was not current on vaccinations. There were 17 other horses on the farm, including 2 other mare and foal pairs, all reportedly normal.On presentation, the filly was bright, with an estimated body weight of 35 kg and body condition score of 4 of 9. Physical examination findings included a rectal temperature of 391C, heart rate of 104/min, and respiratory rate of 18/min. Mucous membranes were slightly injected and capillary refill time was o2 seconds. Increased bronchovesicular sounds were heard bilaterally on auscultation of the lungs; sounds were accentuated on rebreathing exam. All joints and the umbilicus palpated normally. Diagnostic testing was limited because of owner financial constraints, and included a CBC, thoracic ultrasound examination, and upper airway endoscopy. Ultrasonography identified pleural roughening bilaterally. Endoscopy identified pharyngeal edema and copious white purulent material in the trachea (score 5/5 1 ) and pharynx, which was collected for culture and cytology. Treatment initiated on the farm, based on a working diagnosis of bacterial pneumonia and pending laboratory results, included ceftiofur a (4 mg/kg SC q12h  2 days, then 4 mg/kg SC q24h) for suspected pneumonia, flunixin meglumine b (1 mg/kg IV, once) to reduce inflammation and pyrexia, clenbuterol c (0.8 mg/kg PO q12h) as a bronchodilator, and guaifenesin d (3 mg/kg PO q12 h) as an expectorant.Lymphopenia (268/mL; reference range, 1,730-4,850/ mL 2 ) and monocytosis (1,208/mL; reference range, 50-630/mL 2 ) were present on the CBC. Cytology identified numerous leukocytes, cuboidal and columnar epithelial cells, and extracellular and intracellular cocci. Culture yielded Staphylococcus intermedius, Streptococcus suis, and Streptococcus zooepidemicus, all sensitive to most antibiotics, including ceftiofur. The marked lymphopenia and monocytosis, cytology findings, and culture results all supported a diagnosis of bacterial pneumonia. There was a concern that the filly could have an immunodeficiency disorder based on the profound lymphopenia.Four days later, the filly's attitude was still bright, but she had a neutrophilia (10,788/mL; reference range, 2,760-9,270/mL 2 ) with a left shift (116/mL bands), and lymphopenia (348/mL). The persistent abnormalities were attributed to the severity of the foal's disease. Based on evidence of clinical improvement, the initial treatment plan was continued with the addition of flunixin meglumine (1 mg/kg PO q24h) if the temperature remained above 38.91C.Over the next 4 days, the filly had episodes of pyrexia. She was r...