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Multinodular pulmonary fibrosis in five horses

David M. Wong DVM, MS, DACVIM1, Rodney L. Belgrave DVM, MS, DACVIM2, Kurt J. Williams DVM, PhD, DACVP3, Fabio Del Piero DVM, PhD, DACVP4, Cody J. Alcott DVM5, Steven R. Bolin DVM, PhD6, Celia M. Marr DVM, PhD7, Rose Nolen-Walston DVM, DACVIM8, Ronald K. Myers DVM, PhD, DACVP9, and Pamela A. Wilkins DVM, PhD, DACVIM, DACVECC10
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  • 1 Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, IA 50011.
  • | 2 Mid-Atlantic Equine Medical Center, 40 Frontage Rd, Ringoes, NJ 08551.
  • | 3 Department of Pathobiology and Diagnostic Investigation, College of Veterinary Medicine, Michigan State University, East Lansing, MI 48824.
  • | 4 Department of Pathobiology, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, PA 19348.
  • | 5 Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, IA 50011.
  • | 6 Department of Pathobiology and Diagnostic Investigation, College of Veterinary Medicine, Michigan State University, East Lansing, MI 48824.
  • | 7 Beaufort Cottage Stables, Newmarket, Suffolk CB8 8JS, England.
  • | 8 Department of Clinical Studies, Sections of Large Animal Medicine, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, PA 19348.
  • | 9 Department of Veterinary Pathology, College of Veterinary Medicine, Iowa State University, Ames, IA 50011.
  • | 10 Department of Clinical Studies, Sections of Large Animal Medicine, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, PA 19348.

Abstract

Case Description—5 horses were evaluated because of decreased appetite, weight loss, fever, cough, tachypnea, and respiratory distress.

Clinical Findings—Tachycardia, tachypnea, increased respiratory effort, lethargy, fever, poor body condition, and nasal discharge were detected in various combinations on initial physical examination. Evaluation of the lower portion of the respiratory tract via radiography and ultrasonography revealed a severe nodular interstitial pattern. Histologic examination of lung tissue revealed interstitial expansion of alveolar parenchyma with collagen, intraluminal accumulation of neutrophils and macrophages within the alveoli, and occasional intranuclear inclusion bodies within alveolar macrophages. Equine herpesvirus type 5 was detected in samples of lung tissue, bronchoalveolar lavage fluid, or both via polymerase chain reaction assay in all cases. A diagnosis of equine multinodular pulmonary fibrosis (EMPF) was established.

Treatment and Outcome—Horses were provided supportive treatment and were administered a variety of medications including corticosteroids and acyclovir. Two horses survived and returned to their previous level of activity. Three horses were euthanized because of either deterioration of clinical condition (n = 2) or failure to improve within 4 weeks of initiation of treatment (1).

Clinical Relevance—EMPF should be considered as a differential diagnosis for adult horses with interstitial pneumonia and should be suspected on the basis of characteristic radiographic, ultrasonographic, and histopathologic findings. Equine herpesvirus type 5 is found in association with EMPF; although the exact pathogenic role this virus plays in EMPF is unknown, equine herpesvirus type 5 may be an etiologic agent or cofactor in the development of EMPF.

Abstract

Case Description—5 horses were evaluated because of decreased appetite, weight loss, fever, cough, tachypnea, and respiratory distress.

Clinical Findings—Tachycardia, tachypnea, increased respiratory effort, lethargy, fever, poor body condition, and nasal discharge were detected in various combinations on initial physical examination. Evaluation of the lower portion of the respiratory tract via radiography and ultrasonography revealed a severe nodular interstitial pattern. Histologic examination of lung tissue revealed interstitial expansion of alveolar parenchyma with collagen, intraluminal accumulation of neutrophils and macrophages within the alveoli, and occasional intranuclear inclusion bodies within alveolar macrophages. Equine herpesvirus type 5 was detected in samples of lung tissue, bronchoalveolar lavage fluid, or both via polymerase chain reaction assay in all cases. A diagnosis of equine multinodular pulmonary fibrosis (EMPF) was established.

Treatment and Outcome—Horses were provided supportive treatment and were administered a variety of medications including corticosteroids and acyclovir. Two horses survived and returned to their previous level of activity. Three horses were euthanized because of either deterioration of clinical condition (n = 2) or failure to improve within 4 weeks of initiation of treatment (1).

Clinical Relevance—EMPF should be considered as a differential diagnosis for adult horses with interstitial pneumonia and should be suspected on the basis of characteristic radiographic, ultrasonographic, and histopathologic findings. Equine herpesvirus type 5 is found in association with EMPF; although the exact pathogenic role this virus plays in EMPF is unknown, equine herpesvirus type 5 may be an etiologic agent or cofactor in the development of EMPF.

Contributor Notes

Address correspondence to Dr. Wilkins