Multisystemic eosinophilic epitheliotropic disease in a horse in Brazil

Abstract

Equine multisystemic eosinophilic epitheliotropic disease (MEED) is a rare disease, characterized by eosinophilia and eosinophilic infiltration of several organs. A 5-year-old horse presented pruritus, areas of alopecia, and moderate eosinophilia. The horse was treated with corticosteroids and antibiotics without substantial improvement; and after the disease progressed to fever, diarrhea, gastric reflux and progressive weight loss. Due to poor prognosis the horse was euthanized. Necropsy revealed poor body condition, multiple to coalescing foci of alopecia, with epidermal ulcerations and crusts on the head and distal parts of the limbs. The proximal duodenum was enlarged, with 3 intraluminal nodules. Histopathological evaluation revealed eosinophilic granulomas in the skin, oral mucosa, duodenum, pancreas, and mesenteric lymph nodes, which were associated with infiltrates of eosinophils, lymphocytes, macrophages, multinucleated giant cells, and occasional plasma cells, along with fibrovascular connective tissue proliferation. MEED should be included in the differential diagnosis of horses with skin lesions concomitant with clinical signs of gastrointestinal illness.

Equine multisystemic eosinophilic epitheliotropic disease in two horses in Italy

“…Both of our patients presented with relative eosinophilia; these data are consistent with some previous reports (Black & Mace, 2004; Bosseler et al., 2013; Carmalt, 2004; Gibson & Alders, 1987; Henson et al., 2002; Laisse et al., 2017; Latimer et al., 1996; McCue et al., 2003). However, eosinophilia is an inconsistent feature in EMEED cases.…”

“…Both patients in this study were not febrile at the time of admission, which is consistent with previously reported cases (Henson et al., 2002; La Perle et al., 1998; Latimer et al., 1996; Nimmo Wilkie et al., 1985; Sanford, 1989). Conversely, neither of them presented with diarrhoea, which is commonly reported in several EMEED cases (Black & Mace, 2004; Gehlen et al., 2003; Gibson & Alders, 1987; Henson et al., 2002; Laisse et al., 2017; Pass & Bolton, 1982; Platt, 1986), presumably due to malabsorption caused by eosinophilic infiltration. The ventral abdominal and limb oedema, as seen in Case 1, is an inconsistent clinical sign, but has been previously reported in some cases (Gibson & Alders, 1987; Laisse et al., 2017; Latimer et al., 1996), believed to be a consequence of the protein loss from the infiltrated small intestine.…”

“…Equine multisystemic eosinophilic epitheliotropic disease is a rare condition affecting several organ systems (La Perle et al., 1998; Singh et al., 2006). Less than fifty cases have been reported in the literature prior to 2013 (Pucheu‐Haston & Del Piero, 2013), and only another report was described during the following four years (Laisse et al., 2017). To date, no EMEED cases have been reported in Italy.…”

“…Equine multisystemic eosinophilic epitheliotropic disease (EMEED) is a rare, chronic condition usually affecting young horses (2–4 years of age), but potentially occurring at any age (La Perle et al., 1998). Although Standardbreds and Thoroughbreds are thought to be predisposed (Black & Mace, 2004; Sanchez, 2018; Sanford, 1989; Schumacher et al., 2000), this disease can also affect horses of other breeds (Carmalt, 2004; Henson et al., 2002; La Perle et al., 1998; Laisse et al., 2017; Latimer et al., 1996; McCue et al., 2003; Platt, 1986; Singh et al., 2006). EMEED is characterised by eosinophilic infiltration of multiple organs.…”

“…EMEED is characterised by eosinophilic infiltration of multiple organs. Skin, gastrointestinal tract, liver, pancreas, lungs and lymph nodes are commonly involved (Black & Mace, 2004; Bosseler et al., 2013; Carmalt, 2004; Gehlen et al., 2003; Gibson & Alders, 1987; Henson et al., 2002; Horan et al., 2013; La Perle et al., 1998; Laisse et al., 2017; Latimer et al., 1996; McCue et al., 2003; Nimmo Wilkie et al., 1985; Pass & Bolton, 1982; Platt, 1986; Sanford, 1989). The clinical presentation may vary according to the organs affected (Singh et al., 2006).…”