Lymphocytic-Plasmacytic Enterocolitis

Outline

Overview
Signalment
Signs
Causes and Risk Factors

BASICS

Overview

LPE is a pathologic description of a type of infiltrative intestinal disease within the complex of idiopathic inflammatory bowel disease in the horse
Malabsorption and protein-losing enteropathy result from the diffuse infiltration of well-differentiated lymphocytes and plasma cells into the lamina propria, between crypts, and sometimes in the submucosa of the small intestine and to a lesser extent the large intestine
Lesions involving the small intestine are more common than lesions involving the large intestine. Normal fecal consistency indicates that the majority of the large intestine is functional
LPE is an uncommon equine intestinal disease that is difficult to diagnose antemortem

Signalment

No breed, age, or sex predisposition
Median age 12 years (n = 14)

Signs

Chronic weight loss (95%)
Thin to emaciated
Generalized weakness
Lethargy (20%)
Inappetence (50%)
Normal feces consistency or diarrhea (35%). Diarrhea indicates that LPE involves the large intestine
Normal vital signs
Recurrent colic (20%)
Per rectal examination—firm mass in the craniodorsal abdomen suggestive of mesenteric lymphadenopathy in the region of the cranial mesenteric artery possible (3/12)

Causes and Risk Factors

Exact cause is unknown, although there is a strong probability that LPE is an immune-mediated disorder.

Diagnosis ⬆ ⬇

Outline

Differential Diagnosis
CBC/Biochemistry/Urinalysis
Other Laboratory Tests
Imaging
Other Diagnostic Procedures

DIAGNOSIS

Differential Diagnosis

Malnutrition
Internal parasitism
Granulomatous enteritis
Alimentary lymphosarcoma
Eosinophilic enteritis
Multisystemic eosinophilic epitheliotropic disease
Tuberculosis
Histoplasmosis
Basophilic enterocolitis

CBC/Biochemistry/Urinalysis

Hypoalbuminemia (<30 g/L) (11/20)
Hypoproteinemia (<60 g/L) (7/20)
Hyperbilirubinemia if horse is inappetent
Increased plasma fibrinogen (5/8)
Normal urinalysis

Other Laboratory Tests

d-Xylose absorption test/oral glucose tolerance test abnormal (14/17)
Serum protein electrophoresis abnormal

Imaging

N/A

Other Diagnostic Procedures

Rectal mucosal biopsy—abnormal (3/7). Moderate to large numbers of lymphocytes and plasma cells seen in the lamina propria. Unlikely to be diagnostic as lymphoid and plasma cells may also be found in rectal tissue of horses with granulomatous disease, cyathostomiasis, and malignant lymphoma
Definitive diagnosis by small intestine biopsy—standing flank or laparoscopy; infiltration with lymphocytes and plasma cells

Treatment ⬆ ⬇

TREATMENT

Poor prognosis.

Medications ⬆ ⬇

Outline

Drug(s) of Choice
Contraindications/Possible Interactions

MEDICATIONS

Drug(s) of Choice

Corticosteroids (e.g. prednisolone 1 mg/kg PO every 12 h or dexamethasone 0.1 mg/kg IM every 24 h for 3 days, then 0.02 mg/kg IM). Anecdotal reports of brief resolution of diarrhea in some cases when given for several weeks.

Contraindications/Possible Interactions

Corticosteroids at this dosage may be immunosuppressive and also may have significant metabolic side effects. Therapy should be withdrawn gradually.

Follow-up ⬆ ⬇