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  Discussion on Purpura hemorrhagica as a cause of colic
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DrO

Posted on Friday, Jul 8, 2005 - 1:49 pm:

Here is a bit of an oddity that combines Strangles, colic, and lameness all in one package. Essentially what we have here is an unusual presentation of the autoimmune complication of Strangles exposure or vaccination called purpura hemmoragica. This is where the activated immune system results in inflamed blood vessels called vasculitis. Instead of inducing swollen hot painful legs blood vessels, in this form the vessels become clogged (infarcted) and cause colic and muscle swelling with pain.

The fact that five cases were found by a single institution suggests this may not be that rare and and most importantly early diagnosis and aggressive treatment that would different than standardly given to horses with colic may save the horses life. The key seems to be to remember recent exposure to Strangles or Strangles vaccination.

J Am Vet Med Assoc. 2005 Jun 1;226(11):1893-8, 1845.
Infarctive purpura hemorrhagica in five horses.

Kaese HJ, Valberg SJ, Hayden DW, Wilson JH, Charlton P, Ames TR, Al-Ghamdi GM.

Department of Veterinary Population Medicine, College of Veterinary Medicine, University of Minnesota, Saint Paul, MN 55108, USA.

Five horses were examined because of signs of muscle stiffness, colic, or both. All 5 had been exposed to Streptococcus equi within 3 weeks prior to examination or had high serum titers of antibodies against the M protein of S equi. Horses had signs of unrelenting colic-like pain and focal areas of muscle swelling. Four horses were euthanatized. The fifth responded to treatment with penicillin and dexamethasone; after 3 weeks of treatment with dexamethasone, prednisolone was administered for an additional 10 weeks. Common hematologic and serum biochemical abnormalities included neutrophilia with a left shift and toxic changes, hyperproteinemia, hypoalbuminemia, and high serum creatine kinase and aspartate transferase activities. Necropsy revealed extensive infarction of the skeletal musculature, skin, gastrointestinal tract, pancreas, and lungs. Histologic lesions included leukocytoclastic vasculitis in numerous tissues and acute coagulative necrosis resembling infarction. These horses appeared to have a severe form of purpura hemorrhagica resembling Henoch-Schonlein purpura in humans and characterized by infarction of skeletal muscles. Early recognition of focal muscle swelling, abdominal discomfort, neutrophilia, hypoalbuminemia, and high serum creatine kinase activity combined with antimicrobial and corticosteroid treatment may enhance the likelihood of a successful outcome.

DrO
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