Equine multisystemic eosinophilic epitheliotropic disease in two horses in Italy

Equine multisystemic eosinophilic epitheliotropic disease (EMEED) is a rare condition characterised by eosinophilic infiltration of multiple organs. The aim of the present work was to describe two clinical cases that occurred in Italy, where no previous EMEED cases have been reported. A 2-year-old Standardbred colt was referred for poor body condition, multiple oral ulcerations, ventral and limb oedema, nasal discharge and coughing. Relative eosinophilia, increased ALP, GGT, LDH and hypoalbuminaemia were detected. Abdominal ultrasonography showed hepatomegaly and hepatic biopsy revealed eosinophilic hepatitis. After euthanasia, post-mortem examination revealed eosinophilic infiltration and fibrosis of intestinal wall, liver, pancreas and mesenteric lymph nodes. The second case was a 13-year-old pony hospitalised for acute respiratory distress, poor body condition, nasal discharge, cough and dyspnoea. Leucocytosis with relative eosinophilia was detected. Thoracic ultrasonography showed disseminated comet tail artefacts. Endoscopy of the airways revealed disseminated white nodules in the nasal cavities and nasopharynx; biopsy showed eosinophilic infiltrates. After euthanasia, post-mortem examination revealed eosinophilic infiltration of intestinal wall, liver, mediastinal lymph nodes, lungs and kidneys. Both patients presented with poor body condition, which is the most common sign of EMEED. They also showed nasal discharge, and the second case showed respiratory distress and disseminated white nodules, which have not been reported previously. In both cases, liver involvement was observed. Post-mortem examination provided the most specific findings, such as lymphadenomegaly and eosinophilic infiltration of multiple organs. Although weight loss remains the main sign of EMEED, liver and airway evaluation was extremely useful for the diagnosis in these cases.