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EQUINE VETERINARY EDUCATION / AE / SEPTEMBER 2017
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samples were sent for bacterial culture. The cytological appearance was characterised by an increased white blood cell count (26.3 9 109/ll; rr <0.5 9 106/l), of which 84% were neutrophilis with signs of degeneration and high protein concentration (53 g/l; rr 9.0–30 g/l). Bacteriological cultures of both samples were positive and S. zooepidemicus was isolated. This confirmed the diagnosis of a septic lesion of the DDFT and septic tenosynovitis of the DFTS of the left hindlimb.
Treatment
Fig 5: Transverse ultrasonographic image obtained at the level of the pastern. The hypoechogenic area involves the medial lobe of the deep digital flexor tendon (arrow), which appears greatly increased in thickness. Note the effusion of the digital flexor tendon sheath (asterisks).
(Beccati et al. 2015), a tentative diagnosis of a septic lesion of the DDFT and septic tenosynovitis of the DFTS of the left hindlimb was made.
Further examinations Further examinations were used to investigate the respiratory and abdominal systems because the horse had been presented with a history of chronic weight loss, intermittent fever and mild respiratory clinical signs. A complete blood count revealed a mild leucocytosis (11.9 9 109/l; reference range [rr] 5.0–10.0 9 109/l), increased serum amyloid (253 mg/dl; rr: 0.5–20 mg/l) and fibrinogen (7.19 g/l; rr: 0–4g/ l). Indirect immunofluorescence antibody tests (IgG and IgM) for
Theileria equi, Babesia caballi and Anaplasma
phagocytophilum were negative. Thoracic ultrasound showed a mild increase in the amount of pleural fluid and a moderate amount of comet tail artefacts throughout the cranial lung fields. Thoracic radiography, gastroscopy, rectal examination and abdominocentesis revealed no abnormalities. On the basis of the thoracic ultrasound findings
and anamnesis, a transtracheal wash was performed. The fluid collected from the tracheal wash appeared cloudy, with the presence of mucus and no signs of blood. Cytology revealed 59% neutrophilis (rr 20–40%), 31% macrophages (rr 44–65%), 6% columnar epithelial cells (rr 0–30%) and 4% lymphocytes (rr 5–10%). Signs of cell degeneration, such as karyolysis and cytoplasmatic vacuolization, were found in most neutrophilis together with presence of both intracellular and extracellular bacterial cocci. S. zooepidemicus was isolated from the bacteriological culture. Transcutaneous abdominal ultrasonography revealed mild splenomegaly and reduction in the size of the liver (hepatic hypotrophy). Ultrasound-guided intralesional sampling of the DDFT and of the synovial fluid of the DFTS was performed and the
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Surgical drainage of the DFTS was recommended to the owner who declined because of the severity of the lesion and the guarded prognosis for return to full athletic function. Based on the results of sensitivity tests, the horse was started on systemic antimicrobial treatment with cefquinome (Cobactan 4.5%)1 1 mg/kg bwt i.v. every 24 h for 10 days, and local treatment with ultrasound-guided intralesional and intrathecal injection of amikacin (Likacin 500 mg)2 and ceftriaxone (ceftriaxone 1 g)3 for 5 days. This was followed by regional limb perfusion with 2 g of ceftriaxone3 for another 5 days. After this, samples were obtained from the DDFT and DFTS, and bacteriological culture of both samples was negative. Anti-inflammatory therapy with phenylbutazone (Bute 2.2 mg/kg bwt orally every 24 h)4 was performed until discharge. A modified Robert-Jones bandage was applied to the distal limb during hospitalisation. The prognosis was considered good for survival, but guarded for a return to competition because of the risk of adhesions in the DFTS and persistent lameness.
Outcome
The horse was discharged after 19 days of hospitalisation showing a mild improvement in the degree of lameness (American Association of Equine Practitioners grade 2–3/5). Ultrasonographic examination repeated before discharge revealed no further progression of the DDFT lesion. Systemic antimicrobials and anti-inflammatory treatments with cefquinome (Cobactan 4.5%)1 1 mg/kg bwt i.v. every 24 h and phenylbutazone (Bute oral paste)5 2.2 mg/kg bwt orally every 24 h were continued for 15 days after discharge. It was recommended to maintain the horse on box rest for 1 month with a reverse shoe with heel support to reduce tension on the DDFT, and to manage the pain. After this period, the horse was confined in a small paddock for 7 months. About 10 months after discharge, the horse was still lightly lame but able to work and train and, 17 months after initial presentation, the horse was reintroduced to racing. The gelding has now raced 20 times, earning 9282.00 Euros, and is still in training.
Discussion
Septic infections of the tendons are rarely observed in horses. Intratendinous infections generally occur secondary to a penetrating wound or foreign body involving the tendon itself (Wereszka et al. 2007; Goodrich 2011; Pilati et al. 2015). In the literature, DDFT tendonitis is described as a result of strain injuries related to age and exercise or subsequent to direct trauma (Dyson 2010). To the authors’ knowledge, only one case of septic tenosynovitis of the tarsal sheath and suspected sepsis of the lateral digital flexor tendon
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