Are you sure it is Lymphangitis, and not Cellulitis? Or possibly both?
It’s definitely lymphangitis, given the oozing of pus through the skin. From my limited understanding of them, he could certainly have both, but kind of a moot point since the treatment is the same?
My vet always said pus happens with cellulitis. YMMV
Either way, if a horse does not respond to treatment in 48 hrs I would be asking about IV antibiotics.
http://www.thehorse.com/articles/213…g-lymphangitis
http://www.thehorse.com/articles/335…tion-in-horses
Good Luck!
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Lymphangitis vs cellulitis doesn’t really make a difference, except lymphangitis is more likely to occur in a hind leg and leave the leg permanently enlarged. Both are an infection - one of the lymph system and one of the tissues/cells. You can also have vasculitis (infection of the vascular system). Pus through the skin can happen with both.
Been there…not fun, but IS managable.
Thoroughbred gelding has first episode around 8 years old. It would swell then with antiobiotics, coldhosing and 24 hour movement, would return to near normal.
This would happen every 6 months or so.
Then, horse had bad case and the swelling went right up to the groin. Very very painful. Needed IV pain medication and antibiotics and diuretics. After about 2 weeks, the horse was feeling much better but leg swelling did not return to normal size. Horse was sound. Since that point the leg would go up and down more frequently. His fetlock to hock was always enlarged. However, he was also very sound and was an amazing 3’6 jumper even with the fat leg!
What worked for him - 24 hour turnout. Gave up the stall, the horse was out day and night in all weather. Movement was imperative. Wrapping. He required a pressure wrap from fetlock to above hock at all times. With this pressure wrap, his leg was only slightly stocked. Without the wrap his leg would swell significantly. He also didnt move at first with the wrap, but after a few days figured it all out and was able to run. Immediate diuretic and pain management during a flare up. And lastly work. He was ridden 6 days a week, and if couldnt be ridden he was lunged for min 30 minutes. After a workout, his leg swelling was significantly reduced. The worse thing is not moving. Their lympatic system is no longer moving in the leg, so they have to physically move to push the fluid through.
He had been on almost all the antibiotics available during the first few years (always starting with SMZs). What ended up being the only thing to help during his major flareup was actually Baytril. Not a common antibiotic used for horses. After the massive flareup, none of his future ones were related to any infection, just residual pain/swelling that would be reduced in hours with banamine.
Glad to hear that the OP’s horse is improving.
I had one that had an odd immune system, then got cellulitis a time or two, and then the lympahgitis bouts started. It always happened at pretty much the same time of year (basically now) so I always wondered if it was a reaction to something that bloomed or appeared in June. I was never able to find a cause for any of the episodes (no obvious cut, etc). Each episode was worse and and also happened faster. For the final one he was fine when I left the barn in the late morning, and by late afternoon it was really bad. Really bad. I authorized the euthanasia (*) probably not even 24 hours after it started. But he died on his own as the vet was walking up–Cool never did like vets or needles and definitely wanted to do things on HIS terms.
(*) I was on vacation by then. I’d gone out to the barn for a quick ride before leaving on vacation.
Interesting, Peggy.
You just described what my guy goes through too.
He gets his at almost exactly the same time every year - in the last week of June. And it’s easy to time because I leave for a horseshow for the last week of June and first week July every year. For the last 5 (?) years in a row his hind right leg has blown up like a balloon within a few days of the start of the show. Sometimes it’s at the first day of the horseshow, sometimes it’s the few days before we leave. No new cuts, nothing different than any other day of the year. He does have weird little scabby things on his legs that he’s had his whole life, and one year the vet at the show peeled on of them off and said, “yep, there’s your infection point right there!” And while they may be where the bacteria is coming from (or coming through?) they’re no different at the time that the episodes start than any other time. I have also wondered what it is about this exact time of the year that causes it.
Keeping an eye on it this year because he ended up going through an episode in the end of March (first one that’s ever not been in June). So we’re all curious to see whether that was his “annual episode” or if that was just another little flare up that will be followed by the usual June one.
I’ve definitely read it can be caused by an allergic reaction as well, so Peggy and PNW, it’s certainly reasonable to think so!
Update on my guy: His SAA yesterday was 10, so we are done with check-ups and letting him do another week on the same antibiotics and continuing to lessen the banamine further.
I tried wrapping last night, just standing wraps, and his leg was worse this morning. Turned him out for a few hours, and all of a sudden it’s the best its looked. So, no wraps for him, for whatever reason it makes it worse. Not even a bring-down-the-swelling-under-the-wrap-and-move-it-elsewhere, but altogether worse. 
:no: Oh well, easier to not wrap it!
I’m going to lightly ride again tomorrow, first time with just 6cc banamine once a day, and see how he feels. He’ll definitely have an ugly leg at times, but it looked pretty OK after his turnout this morning, so no complaints. I wish he was cooperative enough for 24/7 turnout, or we had the set-up at the current farm to have a run out, but no such luck.
Hum. I think actually the suffix -itus means inflammation, not necessarily infection. Chronic inflammation can cause different types of -itus related disorders, none of which mean infection. You treat an inflammatory process without infection completely different. It sounds like the OP has Lymphangitus secondary to an infection or at least, it appears to be secondary to infection.
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You have my sympathy. Went through a bout of lymphagitis late last year.
My horse’s leg continued to swell when he was stalled for about 3 months. Eventually, his immune system rebounded and it began looking better after being in the stall overnight. Hang in there. Because my horse was sound while going through this too, my vet advised to put him to work. I began riding almost right away and that also helped manage the swelling. If I didn’t ride, I at least would free lunge to make sure he got his blood pumping. He also got turned out all day (during last winter).
Best of luck!!
I hope things are going better! Lots of well wishes headed your way from the Rockies!
My horse has had a couple bouts with cellulitis since you last saw us. Hot, swollen leg so painful to the touch that if you apply any pressure to it she’ll raise it to stifle level and out sideways trying to get away from the bad touch. Like an equine yoga balance pose. We had similar failure with wrapping: painful compression -> no movement, even with a huge runout at her disposal -> equal or greater edema when all’s said and done. You know how unusual it is for my horse not to be on the move, too! :eek: When I tried to re-wrap the next day she panicked when I started wrapping, broke loose, and ran into her paddock bucking and kicking until she was free of the evil wrap. She killed an ice boot dead in a similar manner during the worst of it. When compression and movement are both indicated, I always prioritize movement now! Your guy is more sane than my horse, but still I wanted to chime in with an anecdote to support the idea that wrapping is counter-productive in some cases of extreme tenderness.
I hope the riding movement is helping. He’s got the best owner and barn folks in his corner, so I’m optimistic that you’ll get it under control. 
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Sounds like she reacted exactly the way he does to wrapping!! He was OK in standing wraps, he walked around in them OK, but they strangely made the swelling much worse, so I assume he moved less with them than without them. He’s sane, but he’s also reminded me through all of this that he does NOT tolerate any wrap or boot below his hind fetlocks. Which I knew from our trainer extraordinaire telling me that he hates those German rubber shipping boots, but just hadn’t experienced, until now.
We definitely learned the same lesson, to prioritize movement! Which was our favorite lameness vet’s most emphatic advice as well.
He’s definitely over the hump now, and his leg looks pretty good with a few hours of turnout or an hour of light riding, so I can’t complain! It won’t ever look right though. We’re done with meds this coming weekend, though he’s going to be on probiotics and GastroGard for quite a while, to be safe.
Worth a try, although I actually suspect that cold-hosing also made his leg worse throughout this bout… there’s the logic that cold-hosing helps with the heat of inflammation, but also the logic that it tightens the lymphatic system and restricts the flow out of the leg. I think the latter proved true in this case…
That does make sense - but if you cold hose immediately after work/turnout when the leg is the tightest it will be…hopefully that coaxes the tissues/cells to stay smaller rather than stretching right back out.
I should note that all of my experience is with cellulitis in the front legs, but we have a horse in the barn who has recurrent lymphangitis and he does have a leg significantly larger than the other around the fetlock and partway up the cannon bone.
Unfortunately I’ve seen quite a few horses with lymphangitis over the years, including 2 with recurring episodes. So I’m not shocked by his leg remaining larger, but do want to ensure it doesn’t cause him discomfort, so keeping him moving is my priority.
Could his lymphatic system be damaged and now you are dealing with lymphadema? That was a concern with my guy .
I assume that would be the official term for it? I’ve seen it in most horses that have had lymphangitis, they have a fatter leg for the rest of their lives. Some had recurrent lymphangitis, others didn’t. Generally it doesn’t bother them. Mine seems to be fine as well, he was completely sound on it last night when I rode him. It came down A LOT with that light ride, but it still doesn’t look right even then.
It’s interesting to me how variable these legs can be.
With Yo his leg was tighter, and more useful, ie he walked more freely after cold hosing.
My vision of the reason cold hosing helps is that it increases circulation. With pressure more so, as it also has a massaging effect.
At one point, when his leg was definitely over the ump, he would twitch that lip and lift his hind leg for me to hit certain spots on his big leg with the jet of the cold hose.
I’ve definitely watched his leg increase in size with cold-hosing. I wonder if there’s a difference in the issues with certain horses so it helps some but not others? I’m not a science person, just watching my one particular horse have found a lot of the usual treatments to have a negative impact. And reading anything and everything I can, many say opposite things - wrapping vs. not, cold-hosing vs. not, forcing to move vs. waiting till they are comfortable (forcing to move made mine better, for sure - as soon as I started lunging he came sound). At least they’re all consistent on anti-inflammatories, antibiotics, and diuretics!
I assume he’s standing still while you are cold hosing, so perhaps the hosing is not cold enough and not enough pressure to prevent the fluid from returning. You could try some ice packs/boots and wrap those on snugly and go for a slow walk right after working him - see if the cold + compression helps.
To truly make an effect with just cold hosing, it has to be really cold water and you have to have water running over the whole affected area, which is hard to do with a hose (the Leg Soakers are really good for this). When I ice, I always wet the leg too so it gets colder.
I know he doesn’t necessarily do turnout well, but ideally you would work him, ice him, and wrap him or turn him back out for slow, constant movement.
