Clinical and Pathophysiological Features of Granulomatous Enteritis and Eosinophilic Granulomatosis in the Horse

Abstract

Summary The interrelationships between clinical, clinicopathological and morphological findings were studied in 17 cases of equine granulomatous enteritis (GE) and 19 cases of equine eosinophilic granulomatosis (EG) in order to define criteria for clinical diagnosis and to elucidate pathophysiological events in these disorders. Both diseases were marked by progressive wasting and hypoalbuminaemia. They occurred sporadically and showed a predilection for 1‐ to 4 year‐old standardbreds. Excessive protein loss into the gastrointestinal tract was demonstrable by 51Cr‐albumin in both disorders. Serum immunoglobulin levels varied greatly. Significant deviations of mean levels included low IgG(T) in both groups, low IgM in GE and low IgG in EG. D‐xylose absorption was poor in GE, reflecting the villous atrophy of the small bowel in the disease, whereas it was quantitatively unimpaired but tended to be delayed in EG. Diarrhoea was common in EG (14 out of 19 cases) and less frequent in GE (4/17), a difference partly explained by differing major disease sites in the gut (large bowel in EG, small bowel in GE). Marked cholangitis and cholangiohepatitis often occurred in EG, being reflected in some animals by high levels of gammaglutamyltranspeptidase and the appearance of a bile duct isoenzyme of alkaline phosphatase in the serum. Several horses in the EG group showed severe dermatopathy, often including coronitis and loss of chestnuts, whereas severe skin lesions were only occasionally found in the GE series. Anaemia was often present in GE (11/17) but rare in EG (1/19). The study indicated that, although clinical and laboratory findings in EG and GE show much overlap, several features that help to distinguish between the two disorders in the live animal do exist. The results are discussed in the light of possible pathophysiological and pathogenetic mechanisms. Zusammenfassung Klinische und pathophysiologische Merkmale der granulomatösen Enteritis und der eosinophilen Granulomatose beim Pferd Die wechselseitigen Beziehungen zwischen klinischen, klinisch‐pathologischen und morphologischen Befunden wurden in 17 Fällen von equiner granulomatöser Enteritis (GE) und in 19 Fällen von equiner eosinophiler Granulomatose (EG) untersucht, um Kriterien für die klinische Diagnose zu definieren und um die pathophysiologischen Abläufe bei diesen Störungen zu klären. Beide Krankheiten waren gekennzeichnet durch eine progressive Verschlechterung und Hypoalbuminämie. Sie traten sporadisch auf und zeigten eine Prädilektion für ein bis vier Jahre alte Traber. Mit Hilfe von 51Cr‐albumin ließ sich bei beiden Störungen ein exzessiver Proteinverlust in den Gastrointestinaltrakt nachweisen. Die Serumimmunglobulinkonzentrationen variierten erheblich. Signifikante Abweichungen von durchschnittlichen Konzentrationen betrafen in beiden Gruppen die erniedrigten IgG(T), sowie die niedrigen IgM bei der GE und die niedrigen IgG bei der EG. Die schlechte d‐Xylose‐Absorption bei der GE widerspiegelt die Atrophie der Darmzotten im Dünndarm. Bei der EG war di...

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

“…In general, MEED is a slowly progressive, chronic disease affecting young horses and most often standardbreds and quarter horses (Lindberg et al 1985;Schumacher et al 2000). To our knowledge, this is the first report of a horse with an acute progression of MEED.…”

“…Possible explanations for the quick deterioration of the horse are the presence of severe lesions of the bile ducts, the pancreatic ducts and the intestines and the presence of high fever. Only three previously reported cases have described the presence of fever (Lindberg et al 1985;Platt 1986;Sweeney et al 1986 The majority (95%) of 44 horses previously reported with MEED presented with severe weight loss and 55% had concurrent, sometimes intermittent diarrhoea. In the present case, the severe weight loss and diarrhoea was apparently caused by severe diffuse eosinophilic enteritis.…”

“…Many affected horses showed hypoproteinemia (41%) and hypoalbuminemia (66%) with or without concurrent ventral oedema (Schumacher et al 2000). Hypoproteinemia may have been the result of protein losing enteropathy caused by enteritis (Lindberg et al 1985).…”

Pulmonary and hepatic eosinophilic granulomas and epistaxis in a horse suggestive of multi‐systemic eosinophilic epitheliotropic disease

“…Suggested aetiologies include bacterial, viral, toxic, type 1 hypersensitivity (diet, inhaled, parasitic antigens) and immune‐mediated causes as well as eosinophilopoietic cytokines from activated or neoplastic T‐lymphocytes (Pass and Bolton ; Lindberg et al . ; Nimmo Wilkie et al . ; Sanford ; La Perle et al .…”

Gluten-dependent antibodies in horses with inflammatory small bowel disease (ISBD)

“…If this delicate balance is interrupted, a state of chronic uncontrolled inflammation may ensue (German et al 2003). A syndrome, marked by chronic weight loss and hypoalbuminaemia associated with chronic gastrointestinal disorders is well known in Standardbreds with two different pathomorphological entities, namely eosinophilic granulomatosis and granulomatous enteritis (Lindberg et al 1985). Lymphocytic-plasmacytic enteritis also belongs to this complex of equine idiopathic inflammatory small bowel disease (ISBD).…”