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Equine multisystemic eosinophilic epitheliotropic disease: a case report and review of literature

(2013) NEW ZEALAND VETERINARY JOURNAL. 61(3). p.177-182
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Abstract
CASE HISTORY: A 2-year-old Standardbred gelding presented with a history of fever over 1 week, anorexia and skin lesions on all four legs. The lesions were associated with severe pruritus and oedema, and there was no response to therapy. CLINICAL FINDINGS: The horse was in poor body condition, was lethargic and severely pruritic. Skin lesions consisted of diffuse alopecia and crusting of the distal extremities. Initially it was slightly febrile, but subsequently its temperature increased up to 40 degrees C. Ten days after admission it developed profuse watery diarrhoea and the skin lesions progressed. Skin biopsies revealed superficial and deep perivascular dermatitis with lymphoplasmacytic and eosinophilic predominance. Based on the poor prognosis the horse was subject to euthanasia. PATHOLOGICAL FINDINGS: The most notable lesions included ulcerative gastritis, typhlitis and colitis with prominent oedema of the intestines, marked subcutaneous oedema and severe thickening of the large bile ducts. Histopathology showed marked eosinophilic and lymphoplasmacytic infiltration of various tissues including the skin, gastrointestinal tract, mesenteric lymph nodes, large bile ducts, pancreatic duct and kidney. Immunohistochemistry revealed a clear predominance of CD3-positive cells in the lymphocytic infiltrations. DIAGNOSIS: Based on the clinical findings and histopathology a diagnosis of multisystemic eosinophilic epitheliotropic disease (MEED) was made. CLINICAL RELEVANCE: Multisystemic eosinophilic epitheliotropic disease is rare in horses, and usually chronic. In the current case the horse showed an apparently acute onset with high fever and rapid clinical deterioration. A diagnosis of MEED should be considered in horses presenting with weight loss and skin lesions with or without fever. A final diagnosis is based on histological results of biopsy specimens from affected organs.
Keywords
Equine, horse, MEED, fever, Multisystemic eosinophilic epitheliotropic disease, IDIOPATHIC HYPEREOSINOPHILIC-SYNDROME, HORSE, DERMATITIS, DISORDERS, ENTERITIS

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Citation

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MLA
Bosseler, Leslie, Kirsten Verryken, Caroline Bauwens, et al. “Equine Multisystemic Eosinophilic Epitheliotropic Disease: a Case Report and Review of Literature.” NEW ZEALAND VETERINARY JOURNAL 61.3 (2013): 177–182. Print.
APA
Bosseler, L., Verryken, K., Bauwens, C., de Vries, C., Deprez, P., Ducatelle, R., & Vandenabeele, S. (2013). Equine multisystemic eosinophilic epitheliotropic disease: a case report and review of literature. NEW ZEALAND VETERINARY JOURNAL, 61(3), 177–182.
Chicago author-date
Bosseler, Leslie, Kirsten Verryken, Caroline Bauwens, Cynthia de Vries, Piet Deprez, Richard Ducatelle, and Sophie Vandenabeele. 2013. “Equine Multisystemic Eosinophilic Epitheliotropic Disease: a Case Report and Review of Literature.” New Zealand Veterinary Journal 61 (3): 177–182.
Chicago author-date (all authors)
Bosseler, Leslie, Kirsten Verryken, Caroline Bauwens, Cynthia de Vries, Piet Deprez, Richard Ducatelle, and Sophie Vandenabeele. 2013. “Equine Multisystemic Eosinophilic Epitheliotropic Disease: a Case Report and Review of Literature.” New Zealand Veterinary Journal 61 (3): 177–182.
Vancouver
1.
Bosseler L, Verryken K, Bauwens C, de Vries C, Deprez P, Ducatelle R, et al. Equine multisystemic eosinophilic epitheliotropic disease: a case report and review of literature. NEW ZEALAND VETERINARY JOURNAL. 2013;61(3):177–82.
IEEE
[1]
L. Bosseler et al., “Equine multisystemic eosinophilic epitheliotropic disease: a case report and review of literature,” NEW ZEALAND VETERINARY JOURNAL, vol. 61, no. 3, pp. 177–182, 2013.
@article{3226169,
  abstract     = {CASE HISTORY: A 2-year-old Standardbred gelding presented with a history of fever over 1 week, anorexia and skin lesions on all four legs. The lesions were associated with severe pruritus and oedema, and there was no response to therapy. 
CLINICAL FINDINGS: The horse was in poor body condition, was lethargic and severely pruritic. Skin lesions consisted of diffuse alopecia and crusting of the distal extremities. Initially it was slightly febrile, but subsequently its temperature increased up to 40 degrees C. Ten days after admission it developed profuse watery diarrhoea and the skin lesions progressed. Skin biopsies revealed superficial and deep perivascular dermatitis with lymphoplasmacytic and eosinophilic predominance. Based on the poor prognosis the horse was subject to euthanasia. 
PATHOLOGICAL FINDINGS: The most notable lesions included ulcerative gastritis, typhlitis and colitis with prominent oedema of the intestines, marked subcutaneous oedema and severe thickening of the large bile ducts. Histopathology showed marked eosinophilic and lymphoplasmacytic infiltration of various tissues including the skin, gastrointestinal tract, mesenteric lymph nodes, large bile ducts, pancreatic duct and kidney. Immunohistochemistry revealed a clear predominance of CD3-positive cells in the lymphocytic infiltrations. 
DIAGNOSIS: Based on the clinical findings and histopathology a diagnosis of multisystemic eosinophilic epitheliotropic disease (MEED) was made. 
CLINICAL RELEVANCE: Multisystemic eosinophilic epitheliotropic disease is rare in horses, and usually chronic. In the current case the horse showed an apparently acute onset with high fever and rapid clinical deterioration. A diagnosis of MEED should be considered in horses presenting with weight loss and skin lesions with or without fever. A final diagnosis is based on histological results of biopsy specimens from affected organs.},
  author       = {Bosseler, Leslie and Verryken, Kirsten and Bauwens, Caroline and de Vries, Cynthia and Deprez, Piet and Ducatelle, Richard and Vandenabeele, Sophie},
  issn         = {0048-0169},
  journal      = {NEW ZEALAND VETERINARY JOURNAL},
  keywords     = {Equine,horse,MEED,fever,Multisystemic eosinophilic epitheliotropic disease,IDIOPATHIC HYPEREOSINOPHILIC-SYNDROME,HORSE,DERMATITIS,DISORDERS,ENTERITIS},
  language     = {eng},
  number       = {3},
  pages        = {177--182},
  title        = {Equine multisystemic eosinophilic epitheliotropic disease: a case report and review of literature},
  url          = {http://dx.doi.org/10.1080/00480169.2012.753569},
  volume       = {61},
  year         = {2013},
}

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