Pathology in Practice

Bacon, Rebecca; Bassett, Abbi K; Milliron, Sarai M; Porter, Brian F.; Wiener, Dominique J

doi:10.2460/javma.20.09.0502

Cited by 1 publication

(9 citation statements)

References 11 publications

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“…Multisystemic eosinophilic epitheliotropic disease is an uncommon disease in horses that can be difficult to diagnose ante-mortem due to its unpredictable multi-organ involvement (5,6). The etiology for this condition is not yet fully established (1,3,5).…”

Section: Discussionmentioning

confidence: 99%

“…Clinical presentations of MEED, depending on organ infiltration, can vary widely. Documented cases with this disease have most reliably shown signs of chronic weight loss and frequent dermatologic abnormalities (1,3,5,6,7). Inconsistent features include pyrexia, respiratory distress, pancreatitis, coronitis, hepatitis, recurrent colic, oral ulceration, and a change in appetite (1,6,7).…”

Section: Discussionmentioning

confidence: 99%

“…Documented cases with this disease have most reliably shown signs of chronic weight loss and frequent dermatologic abnormalities (1,3,5,6,7). Inconsistent features include pyrexia, respiratory distress, pancreatitis, coronitis, hepatitis, recurrent colic, oral ulceration, and a change in appetite (1,6,7). When eosinophils permeate the gastrointestinal tract, this condition is considered a subcategory of inflammatory bowel disease (1,4,6,7).…”

Section: Discussionmentioning

confidence: 99%

“…The diagnosis of multisystemic eosinophilic epitheliotropic disease (MEED) relies on a process of exclusion (1,6). In this case, no identifiable etiologic agent was found on histologic examination, therefore reducing the suspicion of Pythium insidiosum, Habronema sp.…”

Section: Multisystemic Eosinophilic Epitheliotropic Disease In a Horsementioning

confidence: 94%

“…Differential diagnoses: Differentials for eosinophilic inflammation in horses are multisystemic eosinophilic epitheliotropic disease (MEED), disseminated mast cell tumor, Heterobilharzia americana infection, Pythium insidiosum infection, or habronemiasis (1). Additional considerations for chronic, progressive exfoliative dermatitis include paraneoplastic syndrome from lymphoma (2), pemphigus foliaceus, and photosensitization from pyrrolizidine alkaloid toxins (3).…”

mentioning

confidence: 99%

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Multisystemic eosinophilic epitheliotropic disease in a horse

Thielemann,

Lui,

McAda

et al. 2024

BJVP

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A 16-year-old paint mare presented to the Texas A&M equine emergency medicine service for chronic weight loss despite an adequate appetite, inappropriate mentation, and hair loss. Clinical signs started three months prior with a history of gradual weight loss that did not respond to prophylactic oral deworming, diet change, or dental float. The horse then began displaying signs of pruritus with self-inflicted patchy alopecia primarily localized to the pigmented skin followed by rapid epaxial and gluteal muscle atrophy and fluctuant swelling around the head and neck (Fig. 1). Palpable, firm skin nodules appeared in the cervicothoracic, pectoral, axillary, and inguinal regions (Fig. 2). The mare also began exhibiting signs of colic, decreased borborygmi and dry fecal matter. Despite an initial two-day improvement with gastric decompression, anti-inflammatory medications, and supportive care, the horse became acutely neurologic with abnormal mentation and right front limb lameness/paresis. See video: https://youtu.be/NbiVcdOOkg0Neurologic signs significantly worsened over the next three days to pyrexia, weakened tail tone, abnormal right hind stride, generalized ataxia, head pressing, and violent outbursts. Hematology revealed a stress leukogram with a moderate mature neutrophilia (11,537 cells/μL), mild lymphopenia (695 cells/μL), and mild eosinophilia (1,390 cells/μL). Chemistry analysis revealed hyponatremia (128 mmol/L), hyperphosphatemia (5.6 mg/dl), hyperglobulinemia (4.4 g/dl), hyperbilirubinemia (4.9 mg/dl), elevated ALP (534 U/L), elevated AST (722 U/L), elevated lactic acid (32 mg/dl), and elevated creatinine kinase (1293 U/L). Ultrasound evaluation showed pleural effusion, a heterogenous liver, and an enlarged lymph node within the cecal band. Physical exam further revealed multifocal ulcerations on the buccal mucosal surfaces and severe muscle wasting. Due to the diffuse and severe nature of the disease and poor prognosis, the horse was humanely euthanized.Necropsy Findings: Multiple thickened areas of alopecia with superficial crusting were distributed across the abdomen, pectoral, and inguinal areas, with preference to pigmented skin. *The Diagnostic Exercises are an initiative of the Latin Comparative Pathology Group (LCPG), the Latin American subdivision of The Davis-Thompson Foundation (DTF). These exercises are contributed by members and non-members from any country of residence. Consider submitting an exercise! A final document containing this material with answers and a brief discussion will be posted on the DTF website (https:// davist-hompsonfoundation.org/diagnostic-exercise/).

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