Search

This article discusses a case report of a 36-year-old woman with chronic hand eczema and lymphedema. The patient experienced frequent flare-ups of lesions on her hands, which often led to infections and worsening lymphedema. After failed treatments with corticosteroids and alitretinoin, the patient was prescribed dupilumab, a monoclonal antibody, which resulted in significant improvement of the eczema, lymphedema, and episodes of lymphangitis. The article suggests that dupilumab may be an effective treatment option for severe chronic hand dermatitis associated with lymphedema. [Extracted from the article]

Summary: Limb cellulitis/lymphangitis is a well‐recognised syndrome in horses, but there are limited published reports concerning outcomes and complications. This report describes a horse with hindlimb cellulitis/lymphangitis that developed ischaemia of the distal limb resulting in necrosis of the suspensory ligament branches and avulsion of the hoof capsule. A 16‐year‐old Thoroughbred mare was referred for further investigation and treatment of a left hindlimb cellulitis/lymphangitis. The culture of a swab taken from superficial pustules on the leg yielded a moderate growth of coliform bacteria and a profuse growth of Staphylococcus aureus. Treatment included systemic antimicrobials (based on the results of culture and sensitivity), phenylbutazone, dexamethasone, morphine and paracetamol. Following some initial clinical improvement, hyperextension of the metatarsophalangeal joint was noted on Day 5 of hospitalisation. Complete avulsion of the ipsilateral hoof capsule occurred on Day 10, and the horse was immediately euthanised. A limited post‐mortem examination revealed necrosis of the suspensory ligament branches. Fibrin thrombi, interstitial haemorrhage and oedema were identified in the suspensory ligament branches and adjacent subcutaneous tissues, with thrombi in relatively large vessels. The dermal laminae were extensively necrotic, and the majority of the lamellar vasculature contained fibrin thrombi. [ABSTRACT FROM AUTHOR]

Summary: Background: Cellulitis is a commonly recognised condition in first opinion equine practice yet there is little published information regarding its diagnosis, treatment and management. Objectives: To describe current approaches of veterinary surgeons working in the United Kingdom (UK) to the diagnosis, treatment and management of distal limb cellulitis in horses. Study design: Cross‐sectional survey. Methods: An online questionnaire was distributed via email and social media sites for a period of 12 weeks. Descriptive statistics were produced and chi‐square or Fisher's exact tests were used to assess associations between categorical variables, with critical probability set at 0.05. Results: Distal limb cellulitis is frequently encountered in the UK, with 83.5% (n = 224/268) of respondents having treated >5 cases in the preceding 12 months. Diagnosis was predominantly made based on clinical signs alone (89.2%; n = 239/268). The majority of respondents (95.5%; n = 256/268) treated cases with nonsteroidal anti‐inflammatory drugs (NSAIDs) and antimicrobials. Phenylbutazone (93.8%; n = 240/256) and trimethoprim sulphonamide (TMPS) (72.3%; n = 185/256) were most frequently prescribed and 61.7% (n = 148/240) of respondents prescribed these drugs in combination. Duration of treatment was most frequently five days for NSAIDs (33.5%; n = 64/191), TMPS (84.4%; n = 119/141) and doxycycline (62.5%; n = 25/40), the longest prescribed duration of any treatments being 10 days. Corticosteroids were administered by 41.0% of respondents (n = 110/268). Management recommendations included cold hosing/ice packing of the affected limb (79.4%; n = 212/267) with light exercise (turnout or hand walking) if the horse was comfortable enough to do so (97.4%; n = 260/267). Main limitations: Small sample size (n = 268) and low level of item omission for a small number of questions. Conclusions: Cellulitis is common in the UK and is usually treated with NSAIDs and antimicrobials for 5–10 days, plus cold hosing and light exercise. Further study on the topics of diagnosis and treatment, with particular emphasis on the aetiology and necessity of antimicrobials, is warranted. [ABSTRACT FROM AUTHOR]

Summary: A 17‐year‐old Irish Draught cross gelding with a history of chronic recurrent right hindlimb cellulitis was evaluated due to acute onset of severe lameness affecting this limb. Scintigraphic examination identified marked radiopharmaceutical uptake within the central and third tarsal bones and the lameness improved following tibial and peroneal nerve blocks. Distal intertarsal joint collapse was observed but the radiographic changes were considered insufficient to explain the lameness severity. Magnetic resonance imaging revealed marked bone pathology affecting both the central and third tarsal bones. A subcutaneous abscess developed on the dorsolateral aspect of the limb, but clear evidence of joint infection was not established. Computed tomography showed lytic lesions affecting mainly the third tarsal bone, so the animal was treated surgically for suspected osteomyelitis involving this bone by implantation of gentamicin impregnated polymethylmethacrylate. Shortly following surgery the horse developed gastric rupture and was euthanased. Osteonecrosis of the third tarsal bone was identified, but sepsis was not demonstrated to be the cause. It is hypothesised that osteonecrosis developed as a sequel to chronic osteomyelitis which may have responded to previous antimicrobial treatment. The report also highlights the importance of gastric disorders as a differential for discomfort in animals undergoing treatment for orthopaedic disease. [ABSTRACT FROM AUTHOR]

After an earlier study defining immunolabeled lymphoid follicles, obstructed lymphatics, and granulomas of the diseased ilea of 24 Crohn's disease patients, we chose to trace the lymphatics of these cases and 10 additional by serial sectioning. Particular attention was given to establishing physical continuity between granuloma-obstructed lymphatics and lymphatics with 'lymphocytic thrombi'. Formalin-fixed paraffin-embedded tissue blocks from resected diseased ilea and proximal colons from 34 patients were reviewed. Patients were 13 men and 21 women, aged 14-60 years. Duration of disease ranged from 1 month to 10 years. Immunohistochemistry employed D2-40 antibody to label lymphatics and anti- CD68 to label granulomas. Twenty-nine of the 34 (85%) resection tissues had lymphangectasia, in mucosa, submucosa, and subserosa. In 53% of the specimens, lymphatics of the various layers were obstructed by granulomas that filled the lumina. In 44%, 15/34, there were also distended lymphatics that were totally plugged with lymphocytes. In 10 of the 15, serial sections revealed continuity between the lymphocyte-plugged lymphatics and the endolymphatic granulomatous obstruction downstream. In 5 of the cases, D2-40 immunostaining revealed redundant lymphatic endothelium interwoven with the granuloma cells. Granulomas totally obstruct lymphatics in all layers of the intestine in Crohn's disease. Upstream of these obstructions, lymphatics are distended with lymphocytes. The degree and extent of this potentially irreversible 'lymphangitis nodosa' have undoubtedly confounded treatment regimens and clinical trials. There currently are no imaging methods to demonstrate the lymphangitis, nor treatments to resolve it. [ABSTRACT FROM AUTHOR]

The case reported here describes an atypical presentation of cellulitis/lymphangitis in an 8-year-old Dutch Warmblood mare. The horse was presented with a history of recurrent episodes of cellulitis/lymphangitis and the presence of fluctuating cyst-like lesions on the left hindlimb. These lesions appeared to be interconnected lymphangiectasias. Surgical debridement followed by primary wound closure and local drainage was performed under general anaesthesia. Twelve months post surgery, no recurrence of cellulitis/lymphangitis had occurred and the mare had returned to her former use as a dressage horse. [ABSTRACT FROM AUTHOR]