lymphangitis/cellulitis upper hind leg

[nativehiro]

Hello! Looking to hear about similar stories/treament with lymphangitis/cellulitis

My horse came in from the pasture about two weeks ago 3-legged lame. I noticed some swelling above the hock into his groin area (which is an odd place for swelling to me). Took some pictures/video for the vet as she is out of state for the season. She suspected he either had a scrape (which where wasn’t anything I could see) or sprain in his groin area that caused enzyme leakage down his leg. The next day his hock area blew up 3x the size.
I started him on SMZ’s and Dex along with cold hosing, and wrapping 2x a day. A week later, he is almost back to normal, and back on T/O.

Yesterday he had a morning massage and was super sore along his back and massage lady pointed out his opposite leg is off (I’m thinking from over-compensation).

Today I noticed he is super stiff again - I am just worried he might of done more than a sprain so I left a message with another vet to see if I can get him looked at.

Does cellulitis take a bit to go away - even if swelling is down? He is a 23 year old war-horse-type OTTB so I just think things are catching up to him, and hate to keep him cooped up.

[Seagram]

I had a horse whose back leg would just blow up when he got scratches. He was out 24/7 (had to be moving to help with the swelling), would hand walk 2-3 times a day, cold hose but also hot towel and massage to try to get the swelling down. Sometimes these episodes would last several weeks, once his leg literally blew out, it was the grossest thing! But according to my vet, we were doing all that we could. I believe this all originally started years before when he had a huge lymphatic reaction to an antibiotic he was given because of a snotty nose. I don’t think his lymph system ever truly recovered, but that’s just my gut feeling. I don’t know if this helps, but I would get a vet involved asap! Lymphangitis/cellulitis can be a huge problem for some.

[mlb722]

Yes, IME it takes some time to fully heal and over compensation definitely can happen. My horse had it reoccurring in her hind leg, it took weeks to get back to normal and even then there was always some stocking up/stiffness. She would often loose hair on her hock area and fluid would come out.
My horse did best with turnout in a small area 24/7 to keep from getting too stiff.

[Foxglove]

Yes. I hope in the last 10 years the treatment options have improved for this. One of our best event horses had a recurring (huge as in elephant size) swelling of his hind leg from hoof to hip. It seemed to be triggered by long trips in the trailer. The vet’s best guess was that his lymph system was blocked in that leg with calcium deposits --when one would break off, it would lodge and we’d have swelling. Nothing helped except what you are doing --cold hosing, general medication. After the swelling went down (2 weeks to a month) horse was fine. This started when he was 20. Because we could no longer haul him, we placed him in a dressage barn where he went from stall to dressage ring and had some turn out. For the rest of his life, he had occasional flare ups --but because he wasn’t hauled, they were less frequent. He died at 33-34 --having continued to be a dressage horse up to his death.

[PNWjumper]

Was he super lame/painful? Cellulitis isn’t usually “just swelling.” The times I’ve dealt with it, the horse does not want to put ANY weight on the leg. And while I have seen slightly more minor varieties, I suspect that they haven’t been “full blown cellulitis” and instead some bacterial infection that responds better/more quickly to antibiotics.

Also, the horse I have who gets cellulitis typically takes much longer to rid himself of swelling. A week of wrapping and SMZs would not make it go away (it usually takes several weeks - and that’s hitting it hard with penicillin or Excede, gentacin, and then 10 days of SMZs).

So I guess all of that to say that I would be more suspicious of an injury to/in his groin that caused the swelling. And maybe it somehow led to a minor infection which responded well to SMZs (or maybe it was just time and not the SMZs that did it)? And if that’s the case, I also would expect there to be a lot of soreness from compensation and the original injury itself.

[nativehiro]

@PNWjumper

Was he super lame/painful? Cellulitis isn’t usually “just swelling.” The times I’ve dealt with it, the horse does not want to put ANY weight on the leg. And while I have seen slightly more minor varieties, I suspect that they haven’t been “full blown cellulitis” and instead some bacterial infection that responds better/more quickly to antibiotics.

Also, the horse I have who gets cellulitis typically takes much longer to rid himself of swelling. A week of wrapping and SMZs would not make it go away (it usually takes several weeks - and that’s hitting it hard with penicillin or Excede, gentacin, and then 10 days of SMZs).

So I guess all of that to say that I would be more suspicious of an injury to/in his groin that caused the swelling. And maybe it somehow led to a minor infection which responded well to SMZs (or maybe it was just time and not the SMZs that did it)? And if that’s the case, I also would expect there to be a lot of soreness from compensation and the original injury itself.

Yes he was just resting the leg and wouldn’t put weight on it when he walked. I am concerned he tore a muscle/broke something in his pelvis, hip area. I have another local backup vet coming out tomorrow as hes still NQR. Swelling has gone down drastically but he really swings leg outwards when he moves. Vet who is out of state suspected some sort of septic swelling from a muscle injury since I couldn’t find a cut.

Here’s day one vs a week after treatment.

[PNWjumper]

IME, if you hit the cellulitis with bigger antibiotics pretty hard, the pain component (from the cellulitis - obviously if an injury caused it, that injury can keep hurting) usually goes away and stays away. I think you’re right to be concerned if he’s still not comfortable on it. The swelling, on the other hand, can last for weeks or even months (though maybe wouldn’t be as apparent where your horse’s is as compared to a lower leg).

But also, I’ve never treated cellulitis without multiple other antibiotics, so I don’t know if that’s the risk you run? IOW, I am definitely not a brilliant resource for you to rely on for information in lieu of a vet!

Either way, I’d sure want a vet to have hands on it and treat it more aggressively than just doing SMZs. Sounds like you’re on the right track.

[punchy]

I used to have a horse who would get stovepipe legs in the winter from the cold/not moving. The first time it started in the hock, like yours; a month later it was a front leg, and we hit it with everything having no idea what it was. The only thing that made it better was hand walking at least an hour every day for over a week. He didn’t want to walk on it but it got better as he moved. The next winter he did it again. We figured out then it was just him not moving enough and very cold weather. I started blanketing him, which helped improve his circulation. I switched to boarding him out in the winter at a facility that had a eurosizer so he could get vigorous exercise daily - brisk walking or jogging that was not possible on my property in the winter on a regular basis. It made a huge difference and he stopped having flare-ups.

If you are relying solely on turnout for his exercise I would say you have to make sure he is actually moving around enough out there. My horse would just stand around or mosey about without getting things moving well enough and it was inadequate for him. Lymphangitis will make them feel sluggish, the swelling will make them painful, both causing them to move around less, which just exacerbates the problem. I hope your guy gets better soon, whatever the problem turns out to be.

[melula]

@nativehiro

Yes he was just resting the leg and wouldn’t put weight on it when he walked. I am concerned he tore a muscle/broke something in his pelvis, hip area. I have another local backup vet coming out tomorrow as hes still NQR. Swelling has gone down drastically but he really swings leg outwards when he moves. Vet who is out of state suspected some sort of septic swelling from a muscle injury since I couldn’t find a cut.

Here’s day one vs a week after treatment.

There is a field assay for serum amyloid A (SAA) that will distinguish between infectious inflammation or inflammation caused by trauma. SAA has historically been associated with general inflammation (trauma or infection). A group out of KY (I think) has determined SAA increases correlate to inflammation caused by infection, but not trauma.

My gelding had cellulitis three weeks ago (or so). We’re still treating associated edema, but the infection is no longer present (confirmed by the assay and other common sense markers).

[Angela_Freda]

It seems to me cellulitis/lymphangitis would show swelling at the hock and below, because of gravity.
Why hasn’t this leg, after a week, shown any inflammation anywhere but very localized and not lower down [per pics]?

[nativehiro]

@Angela Freda

It seems to me cellulitis/lymphangitis would show swelling at the hock and below, because of gravity.
Why hasn’t this leg, after a week, shown any inflammation anywhere but very localized and not lower down [per pics]?

It sort of did this. First two days it was localized but then the next day the hock was the worst of it. I kept it wrapped daily with pressure wraps so it never really got down to the cannon bone area. There was some stocking up around the ankle last few days but he was also left in.

Update:
I did have a vet out - she has seen this a bit with the weather and suspected he most likely slipped in snow/mud and pulled a muscle. Going to treat the lameness with muscle relaxers and bute for the next week or so.Thanks everyone for some input!