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  Discussion on Auto-immune disorder
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New Member:
Amandad

Posted on Friday, Mar 3, 2006 - 2:52 am:

This goes back 5 months now but I want to give you the whole picture.My horse started getting swollen ankles in September. I wasn't sure if it was the new Orchard grass hay as this has been introduced. In October he had ventral edema and some welts. He also had some colic episodes which I attributed to ulcers from the banamine. Ulcer meds alleviated the symptoms. By beginning of November he has severe ventral edema that had oozing scabs. His gaskins were also scabby and he had lower eyelid edema. By this time I figured out he was allergic to the hay and the new sawdust. (Had allergy tests done) He was on Dexasone for over a month as we slowly weaned him off. A biopsy of the edema fluid in his abdomen said:
It is mostly a diffuse dermal infiltrate of histiocytes and lymphocytes with rare formation of nodules around very small centres of necrosis.
There is moderate epidermal thickening from regular acanthosis overlaid by compact orthohyperkeratosis with small serum lakes between keratinocytes in the surface keratin. There is a bit of bubbling at the dermoepidermal junction with a moderate, nodular to mostly diffuse infiltrate of lymphocytes and histiocytes in the follicular dermis(some of these have multiple nuclei) with a solitary granuloma surroounding a central focus of dermal necrosis closely opposed to an adnexal unit. Other cells include fibroblasts, melanophages, and neutrophils.
Can anyone help with an interpretation of this report????
He had another flareup the end of Jan. and we are now weaning him of Dex again as of today. Right now his stomach does not have edema but his gaskins have the painful scabs and I'm not sure if this is an autoimmune problem or if he now has a secondary skin infection.
Moderator:
DrO

Posted on Friday, Mar 3, 2006 - 7:13 am:

You should note that allergy tests in horses are often inaccurate not being very sensitive or selective in the results.

The report suggests that you have small focal areas of cell death in the skin with surrounding inflammation. It does not say what is causing these focal areas of death. They did not find any infectious organisms but sometimes that does not mean they did not exist at some time, particularly if there have been antimicrobial treatments involved. Usually such reports come with conclusions about the nature and possible causes of the disease, what does the person who read the biopsy say they think is the likely cause?

Concerning the current dilemma can you describe the appearance of the scabs and the distribution on the leg? Good photos of the lesions might help.
DrO
New Member:
Amandad

Posted on Friday, Mar 3, 2006 - 12:31 pm:

It said that it's a complicated case. The histological pattern does not match well with either allergies or vasculitis. They suspect it is some sort of 'immune mediated problem'.
I had a transabodominal ultrasound performed in January to rule out lymphoma and there were no abnormalities except for 'an increased amount of small intestine visible in the cranial abdomen on the right side, likely a sequella to fasting and a smaller than normal stomach'. (He was also scoped to confirm ulcers)
I will take a picture today and post it with the one from November when he had his worst blow-up.
P.S. Thank-you so much for all the work you do to help people. I have been studying and reading all the posts here since this started. I've read liver problems, heart problems, steroid use, parasites, and skin problems. I've learned so much. Thanks again.
Moderator:
DrO

Posted on Saturday, Mar 4, 2006 - 7:42 am:

Thank you Amanda,
I cannot disagree with the conclusion of the pathologist. It does not mean you quite looking for other causes like allergies and irritants but you should begin aggressive treatment for the most likely problem, autoimmune skin diseases.

The scabbiness is likely to have started from the autoimmune disease but once started the disrupted skin allows bacteria to take hold. Systemic immune suppressive therapy and topical antibacterial treatment should help get it under control. You might ask the histopathologist if this is consistent with Equine Sarcoidosis (not the same as sarcoids) for more see Equine Diseases » Skin Diseases » Hair and Coat Problems / Itching / Irritated Skin » Sarcoidosis.
DrO
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