Case Report Systemic Granulomatous Disease in a Hungarian Warmblood Gelding Q7 Orsolya Kutasi DVM * , Leticia Moravszki, Sara Sardi, Zsofia Bohak, Imre Biksi, Ferenc Baska, Otto Szenci Q1 Equine Department and Clinic, Faculty of Veterinary Science, Szent Istvan University, ÜllT, Hungary Q2 article info Article history: Received 13 May 2013 Received in revised form 3 January 2014 Accepted 8 January 2014 Available online xxxx Keywords: Horse Granulomatous disease Herpesvirus Spleen Pulmonary fibrosis abstract An 8-year-old Hungarian warmblood gelding used for show jumping was evaluated because of poor performance and chronic weight loss. On admission, oral and gastroesophageal ulcerations and malabsorption were detected. Results of thoracic radiography, ultrasonog- raphy, bronchoalveolar lavage cytology, and positive polymerase chain reaction for equine herpesvirus 5 raised the possible diagnosis of equine multinodular pulmonary fibrosis. However, abdominal ultrasonography revealed inhomogeneous spleen with many different sized well-demarcated hypoechoic areas, which suggested further differential diagnoses such as tuberculosis, neoplasias, immune mediated diseases, systemic granulomatous dis- ease (SGD), or toxicoses. The horse was euthanized at the owner’s request because of the poor condition and possible grave prognosis. Histopathology findings were characteristic of SGD, which is a rare disorder of horses characterized by skin lesions, weight loss, and granulomatous inflammation of multiple organ systems. The lack of skin lesions in this case is an unusual finding. Systemic granulomatous disease is hypothesized to be induced by multiple conventional antigens that are not cleared from affected tissues. Equine herpes- virus 5 might have triggered the granulomatous reactions in this particular case. Ó 2014 Elsevier Inc. All rights reserved. 1. Introduction Systemic granulomatous disease (SGD) is a rare disorder of horses characterized by skin lesions, weight loss, and granulomatous inflammation of multiple organ sys- tems [1–3]. Previously, the disorder was known as equine sarcoidosis because it resembles the systemic noncaseating granulomatous disease, sarcoidosis, seen in humans. Eq- uine sarcoidosis is divided according to several aspects. Based on the extension of the disease “generalized”, “partially generalized” and “localized” forms are distin- guished [4]. Other classification specify the following forms: (1) the scaling and crusting form; (2) the nodular form; and (3) the localized form, in which hyperkeratotic, crusted, alopecic plaques mainly affect the limbs in a sys- temically healthy horse [3,5]. Concurrent with the first two forms, granulomatous inflammation of one or more inter- nal organs can occur, giving rise to the additional clinical signs of weight loss, inappetence, and low-grade fever. In human sarcoidosis, the lungs are most commonly affected; in horses, previously described cases mainly presented with dermal lesions, although there are two equine cases described in the literature without any skin involvement [2,6]. Although the etiology is uncertain in humans, sarcoidosis is thought to be an exaggerated T helper 1 (Th1) lymphocyte immune response to a persistent antigenic stimulus in the affected organs [1,5], and a genetic component has also been identified [2,7,8]. A T-cell-medi- ated immune response is also suspected in horses [5,7]. In the following case, the diagnosis was established post- mortem. The signs were unusual for equine sarcoidosis, * Corresponding author at: Orsolya Kutasi, DVM, Equine Department and Clinic, Clinic for Large Animals, Faculty of Veterinary Science, Szent Istvan University, ÜllT 225, Hungary. E-mail address: kutasi.orsolya@aotk.szie.hu (O. Kutasi). Contents lists available at ScienceDirect Journal of Equine Veterinary Science journal homepage: www.j-evs.com 0737-0806/$ – see front matter Ó 2014 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jevs.2014.01.008 Journal of Equine Veterinary Science xx (2014) 1–6 CRP 5.2.0 DTD  YJEVS1693_proof  30 January 2014  8:35 pm ce 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99