This is going to be a long one as we are scratching our heads…
13 year old Warmblood gelding that was purchased in October from Mexico. He was showing in the grand prix’s and had a consistent show record and no history of soundness or health issues. He was healthy and we hadn’t had any issues with him until March of this year. He went to Thermal and showed for 2 weeks. He arrived home from Thermal on March 14. On March 16 I noticed he had a a small amount of yellowish nasal discharge but otherwise seemed happy and normal. His temp was normal. On March 18 he came out with generalized swelling in his right hind leg and was lame. I had my vet come out that day to look at him. After watching him jog my vet decided to ultrasound him. He said all the soft tissue structures looked good but there was quite a bit of swelling and thought it looked like a cellulitis case. He didn’t have any woulds that we could see but we started him on Naquasone and Uniprim. Within 2 days the swelling had subsided and he had returned to full soundness. He continued on his Uniprim and started back to work.
I left to go out of town the following week and on March 26 got a phone call from the barn that they found him in the stall in the morning with extreme swelling in all 4 limbs and a high fever. This was 10 days into his Uniprim treatment. His temp was 102.8 and he was extremely painful and not wanting to walk. Vet came out immediately and treated with an Exceed shot, Gentamicin and banamine. He also noted he had a small amount of yellowish nasal discharge. We also started cold hosing several times a day and sweating his legs. His SAA was over 3000 and bloodwork came back the next day showing a very high WBC count (I don’t have exact number). The next day his temp was still high and the swelling had increased to all the way to the top of the limbs along with some mild puffiness over his whole body. He was barely able to walk so we decided to take him into the hospital.
The hospital was able to get his temp under control within 48 hours and the swelling slowly started to subside over the next 10 days with cold hosing, walking and sweating. They had suspected that this was possibly caused by Purpura however the titer came back only slightly elevated so they ruled that out. They played around with several different types of antibiotics and felt like they had a handle on everything. Bloodwork had improved and was back within normal ranges. He also had a pustule develop on his nose that ended up rupturing before he went home so they cultured it and it came back positive for Staph.
He was released to come home after 10 days in the hospital. I picked him up around 5pm and brought him home. I was staying at the barn at the time so was able to monitor him throughout the night. I took his temp upon arriving home and it was normal. I wrapped his legs with clean wraps and put him directly in his stall. Wasn’t given any grain, no products used on him besides his meds he came home with. I checked on him at 8pm and he was happy and eating; temp still normal. At his midnight check I noticed he wasn’t eating (he had lost quite a bit of weight so we were keeping food in front of him 24/7) and seemed very quiet. I took temp and it was still normal and his legs were still the same size as when he got home. At his 8am check, he had massively swollen back up to above the knees and hocks and had a temp of 105.2. He was very out of it and having trouble walking. I gave him his am meds and banamine and put him back on the trailer to go to the hospital. Once arriving at the hospital he had perked up and temp was back down to 101. His SAA had increased and WBC count was high again. He stayed at the hospital for another 10 days. The swelling had reduced and his SAA was back around 25. They did biopsies of both hind legs and the findings had come back with immune mediated vasculitis and the vet at the hospital said they suspected it was caused by an allergic response. She had recommended allergy testing. They had done culture with sensitivity on him this time at the hospital and decided that Chloramphenicol was the best antibiotic for him so sent me home with a 7 day supply (he had already been on it for several days).
Since we were worried that it was an allergic response I bought shavings and hay from the hospital so I could keep him on the same products he was being used on there since he was not having a reaction at the hospital. He stayed on Orchard hay (we feed Timothy) and the same brand of shavings for 2 months once returning home.
We went for his allergy test 2 weeks after he came home. I took him to a dermatology center where they did the prick test on him in the trailer. He did not test positive for anything. The vet said he still had quite a bit of edema in his legs so recommended I start him on Pentoxifylline 2x daily. We started on that immediately and his legs improved to almost normal. Front legs could be left unwrapped and would only fill about 10% overnight, hand legs had to remain wrapped otherwise would fill back to about 40-50% but would decrease to about 10% after work. With wraps on at night they would only mildly fill.
His energy level started to improve after about 2.5 weeks off the antibiotics so I started him back to light work. He was sound and hadn’t lost much fitness. I flatted him for about a month and then started jumping again. After about 3 weeks of light jumping (.90-1meter, he had been doing 1.30-1.45 prior to all of this) he started to become very body sore. We stopped jumping, treated with lactanase and banamine for a couple days. He hadn’t improved for a week so I had my vet out.
Vet came out on June 11. He was off on the left front and flexed positive to fetlock flexion. The rest of his body wasn’t examined. Vet said that he probably needed his fetlocks done. He was hesitant to treat him but I said he had been fine and had been on steroids during his hospital stay and that was what had helped finally bring the swelling down (was getting daily dex for a few days and then tapered off). He treated both fetlocks and told me to start him on antibiotics to get ahead of anything. I gave a dose of Uniprim as soon as he left. Fetlocks were wrapped by the vet after injecting and stayed wrapped until the next morning. I checked him that night and noticed a slight amount of swelling in his front legs. By 3pm the next day all 4 legs were swollen to below the knees/above the hocks and had a 102.8 temp and was off feed. I called my regular vet along with the vet at the hospital. Banamine brought his temp down within 3 hours and it did not return. I went and picked up Chloramphenicol and Pentoxy for him and started him on it immediately along with cold hosing and slow walking on the treadmill 3x a day. Vet came out on day 3 and ran an SAA that was 2098 and also sent out bloodwork which came back with a high WBC. Swelling started to subside after about 5 days. His SAA was 591 on June 18 and 24 on June 22. We kept him on antibiotics until June 23 and he is still on Pentoxy. We had tested him for Coryne Psuedotuberculosis and that came back negative.
On June 16 I let my vet know that he was starting to get some skin cracking and weeping on his hind pasterns from the swelling. Within about 2 days the cracking started to become deeper and looked like scabs were developing. The vet didn’t want me to treat them with anything other than Mupirocin. On June 22 the cracks had turned into thick deep scabs and he was very painful to walk but did not have a temp. He improved once I gave him Banamine. We started putting him in the salt water spa 1x a day to help with the scabbing. We did this for a week and it helped soften the scabs but there was no other improvement. The scabs had also developed on his front pasterns and were very thick on every limb. On June 23 he had a small amount of yellowish nasal discharge again but no temp. On July 6 his scabs had pretty much taken over all 4 of his pasterns and were very thick. I emailed his dermatologist and the vet at the hospital. The vet at the hospital recommended using CK Shampoo and really scrubbing the scabs off. The dermatologist recommended starting him on Prednisone for 1 week and not using anything on the scabs or scrubbing them. He suspected that it was Leukocytoclastic Vasculitis. On July 7 I noticed the scabs on the front legs were starting to slough off and within 2 days the scabs were completely gone on the front legs and about 50 % improved on the hind. The edema in the front limbs went away once the scabs were gone and the hind leg edema improved as well. He still has some of the scabs on his hind legs and they are still sore to the touch.
On July 10th I started having him jog on the lunge line. The vet had said to get him moving as soon as the scabs started healing. He had been going on the treadmill 2x a day for 30 mins each time through the whole flare up so has been in some version of light work. When on the lunge line for the first time I noticed he looked body sore which was not the case when he started back to work after the first flare up. He jogged about 5 mins total and didn’t really want to do much and was winded by the end of the 5 mins. I put him back on the lunge line the next day and he looked very sore and stiff. He didn’t have any energy to do anything. On July 13 I got on to tack walk him while I taught a lesson. It was 4pm, his first ride back, no ear plugs, no sedation and he was completely lethargic and was quite sore. I walked around for about 20 mins before getting off.
On July 16 he came out of his stall with a small abscess about 1.5” above his cornet band. It was leaking out a bloody yellow discharge. I cleaned the wound, put him in the salt water spa, wrapped with Furizone and gave a dose of Gentamicin and Banamine as it had been open in the stall and I didn’t want that to cause another Vasculitis flare up. On July 17 a small area above the larger abscess had opened up and was draining a small amount of pus. We did spa, antibiotics, banamine and a wrap again. He hasn’t been lame or had any real tenderness from this. The abscess area was hot and swollen and there was a mild pulse and some swelling in the pastern/fetlock. Shoer came out on July 18 and checked it. There is a dark spot on his hoof right below the cornet band that he tried to open up but couldn’t find anything. He hoof tested positive in his heel. He thought it was very strange that it abscessed up so high as the only other horse he had seem open up that high also had some severe systemic issues going on. He said the abscess was still draining so to keep using the spa and wrapping and he would check him again in a couple days. This evening he also had a bloody nose out of the right nostril.
He lost about 200 lbs during his first bout with this and lost some weight the second time around but has lost all of his topline and muscle tone. He is very lethargic and just not himself. When well, he has quite a bit of blood and tends to be on the spooky side. He hasn’t been like that since this has started.
Has anyone seen anything like this before? Vets are out of ideas and said nothing more can be done until he is in the middle of another active flare up. Any ideas?