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  Discussion on Pemphigus
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New Member:
Dianeky

Posted on Friday, Jul 30, 2004 - 11:33 am:

I have a 5 month old filly who began to exhibit hives and scabby rash which were very itchy over quite a large portion of her body at about 3 1/2 months of age. She was initially treated with 240 mg. prednisolone for five days, which seemed to help. The dose was lowered to 120 mg. per day for 5 days and the leasions began to spread again. The administration of an anti-histimine didn't help. I also noticed that she stopped growing at a normal rate.

Skin scrapings were taken and were negative for bacterial or fungal infection.
Skin biopsies were taken and produced results that are "inconclusive."
Bloodwork (CBC and Chem Screen) shows everything within normal levels.
The hair in the affected areas has been lost, though there is new "fuzz" trying to grow back. The skin in the affected areas is crusty and thickened. She has been confined to the stall to aleviate any possibility of "bug" related allergy. We have begun a feed trial whereby she is being fed only oats and clean alfalfa and a more extensive fungal culture is being grown.

Although we have no definative diagnosis, my vet is leaning towards pemphigus foleacius and wants to treat with steroids to try to get this thing under control.

Having absolutely no experience with anything like this, I am concerned with the use of steroids in such a young horse and am worried about the long term effects on a growing body. I am also disheartened by the prognoses I have read on the internet and would appreciate any feedback anyone could give.

Thanks,
Dianeky
Moderator:
DrO

Posted on Friday, Jul 30, 2004 - 6:56 pm:

Hello Dianeky,
Since you posted this properly, I assume you have read the article. Biopsy inconclusive hmmm... how was the biopsy done, a standard biopsy in formalin is not particularly helpful, perhaps a repeat would be helpful but the horse should be off treatment for several weeks.

If you wanted to test the possibility of an allergy, you could try moving to another farm, stalled to prevent exposure to insects, and put on a diet of straight oats and grass/alfalfa hay and see if you get results.
DrO
Member:
Dianeky

Posted on Saturday, Jul 31, 2004 - 8:53 am:

Hi Doctor,
Thanks for your prompt response. I believe that the standard biopsy was done. There were 7 samples taken and I did hear one of the vets refer to placing the samples in formaldahyde. Since I did begin a feed trial of oats and alfalfa, I decided to delay steroid treatment for a few weeks to see if the diet change produced any results. So, a repeat biopsy shouldn't be a problem. We also have her stalled in an effort to rule out insects and are awaiting the results of a fungal culture.

I have not been able to find an answer to, what is for me, a pressing question. Is auto-immune mediated disease a genetic disorder? I have this filly's dam bred back to the same stallion. This was done before the filly showed any signs of a problem and I am wondering how likely it is that the next baby will have the same thing.

There doesn't seem to be a lot of information out there regarding this type of disease, especially in such a young horse. I truly appreciate this outlet, the opportunity to share info and ask questions.

Thank you,
dianeky
Moderator:
DrO

Posted on Saturday, Jul 31, 2004 - 12:22 pm:

Not in the traditional sense Dianeky. Though in other species there do seem to be some genetic factors that may predispose to the development it is not strickly inherited. The same may be true in horses though specific work on inherited antigens that predispose to the disease has not been done in horses that I can find. Recently a lot more information has come out on this condition and I will attempt next week to update the article.
DrO
Member:
Dianeky

Posted on Sunday, Aug 8, 2004 - 11:14 am:

Hi Dr. O,
Just an update. The filly has been on a food trial of crimped oats and alfalfa for 10 days. There was some improvement after only 5 days and her skin is definately not as "angry" looking. I do still see new eruptions, but they are much fewer in number and not as severe. Any idea as to how long I should give this food trial befor we can come to any conclusion about food allergy?

Thanks
Diane
Moderator:
DrO

Posted on Monday, Aug 9, 2004 - 7:20 am:

You should go as long as the horse is clearly improving. But you should not rely on the improvement alone to diagnose "food allergy". Once well you should try the suspect food stuffs to see if it returns, only then will you have a good idea that was the cause. Remember whatever the cause the outcome was probably going to be it was going to heal: you want to believe the last thing you did was the reason but may not be the case.
DrO
Member:
Dianeky

Posted on Monday, Aug 9, 2004 - 8:43 am:

Dr. O,
Another thing I was thinking about. If we can get a definative diagnosis of pemphigus I would like to donate her to a research facility who may be looking into the problem. Do you have any idea if there are any universities out there who are doing research on the auto-immune diseases and whether or not they would be interested. I've never done anything like this before so I'm not sure how to go about it. Any info would be appreciated.
Thanks,
Diane
Moderator:
DrO

Posted on Tuesday, Aug 10, 2004 - 10:15 am:

Hmmm, looking at the research Diane, there is little of it and comes from all over, probably because you can only take the cases presented which are few and far between. I would ask my veterinarian to contact the most local veterinary school to see if they express an interest in the case.
DrO
Member:
Dianeky

Posted on Tuesday, Aug 24, 2004 - 9:05 pm:

Hi Dr. O.,
I think I have made a breakthrough with this filly. She was doing beautifully with the food trial and I have to say that her condition improved at least 85%. Her hair coat is growing in beautifully and she had very few new scabs. I began to get concerned about giving her strictly alfalfa when I noticed that she looked like she was developing contracted tendons behind....she is growing like a weed again and was starting to have that "knuckled over" look. My vet thought that she might be getting too much calcium in the alfalfa and suggested that I switch her over to strictly clean grass hay. Lo and behold, by the fourth feeding of clean orchard grass she had started to develop new lesions on both sides of her neck. When I though back to when the problem first started, I realized that it began just after I took her and the mare off of alfalfa the first time and put them on timothy.

My question is this....Am I really pulling at straws or is there something that could be upsetting her in grass hay versus alfalfa? My vets don't think that this is an issue. She had been turned out on pasture from the time she was born and that didn't seem to bother her so it seems like the problem is with baled hay.

Any insight you could give would be appreciated.

Thanks,
Diane
Moderator:
DrO

Posted on Wednesday, Aug 25, 2004 - 7:17 am:

It seems very unlikely that the grass hay is the problem CEC but we cannot ignore these observations. First is it possible these hays have been treated or contaminated with something? Another long shot as it appears that 2 diferent types of grass hay have been used. How about selenium conditions where these hays were grown? Do you have deficiency conditions? At this point I would continue the grass until it is clearly worsening then we have to find a way to remove exposure again.
DrO
Member:
Dianeky

Posted on Wednesday, Aug 25, 2004 - 11:02 am:

Dr. O.,
You are correct that there were two types of hay fed. I just got off the phone with the farmer who grows my hay and he said that the only thing that is different with the grass fields (timothy and orchard grass) as opposed to the alfalfa fields is that they fertilize the grass fields with liquid nitrogen. As far as selenium, we are in Pennsylvania and do have a known selenuim deficiency in our soil but it is not so bad that I have ever had to supplement for it.

After checking her again this morning, I can say that the condition IS clearly worstening. I gave her alfalfa this morning and will be interested in seeing if there is a difference in a day or so. In an effort to try to stem the calcium overload, I am going to cut the amount in half. She should be getting enough fiber from the crimped oats. If you have any ideas, I should would appreciate hearing them. I am begining to get to the end of my rope!!!!!!

Thanks,
Diane
Moderator:
DrO

Posted on Friday, Aug 27, 2004 - 8:50 am:

This is interesting because selenium deficiency can cause skin problems and alfalfa is a selenium concentrating plant. Personally I too would expect to see other signs too but this is something easy to address see, Care for Horses » Nutrition » Selenium in Horses.

I don't think it is the calcium causing the tendon contracture problem but more likely the increased overall nutrition provided by the alfalfa. Another good source of fiber and energy would be beet pulp, for its use see the article on forages. While you are at it review trace mineral and vitamin needs and be sure he is receiving adequate levels. By the way CEC has he received any ivermectin treatments? Though I know you say scrappings were negative it can be hard to find some mites.
DrO
Member:
Dianeky

Posted on Friday, Aug 27, 2004 - 10:52 am:

Thanks Fr. O. for your insights. I will check out the info you mentioned. She will be receiveing her first ivermectin worming this week as she has just turned 6 months old. I have decided to go ahead and do the allergy tests via blood serum to see if we can get a handle on whatever is setting her off if it is allergy related. After making this decision, I was told by my small animal vet that the testing for food allergy (in dogs anyway) is very inaccurate. Do you know if the same holds true for horses as well?
Diane
Moderator:
DrO

Posted on Friday, Aug 27, 2004 - 6:30 pm:

As near as I can tell both blood tests and skin challenge tests in horses are without value they fail to recognize established allergy problems while identifying non-allergins as a problem .
DrO
Member:
Dianeky

Posted on Sunday, Sep 19, 2004 - 9:46 am:

Hi Dr. O.,
Wanted to bring you up to speed. The filly is doing wonderfully on alfalfa and oats. I went ahead and had the allergy tests done just to see what came back. The results confirmed that she is allergic to both timothy and orchard grass as well as molasses. Although these test results alone don't provide confirmation of allergy, when viewed along with results of restricted diet I do believe that we can rule out pemphigus----thank goodness. Hopefully she is on the way to a normal life. Thanks for all your insights and for maintaining such a wonderful source of information for horse owners.
Continued success,
Diane
Moderator:
DrO

Posted on Monday, Sep 20, 2004 - 6:56 am:

Thats great Diane, understand that the skin/blood testing is without value and frequently identifies things as a problem that are not, so you should not use it as a confirmation.

However the effects of exposure are suggestive. Once the horse has been normal for a good long time I would try grass hay again cause I am still not completely convinced.
DrO
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