Heterobilharzia americana infection as a cause of hepatic parasitic granulomas in a horse.

CASE DESCRIPTION-A 22-year-old American Paint Horse gelding from the Gulf Coast region of Texas was evaluated for regrowth of a perirectal squamous cell carcinoma that had been surgically removed 11 months previously. CLINICAL FINDINGS-A necrotic and ulcerated mass was present below the anus. The horse had paraphimosis and was having difficulty with urination. Histologic examination of the mass revealed that it was squamous cell carcinoma, and the horse was euthanized because of the unlikelihood that the mass could be adequately resected and its close proximity to the urethra. OUTCOME-At necropsy, in addition to the squamous cell carcinoma, hundreds of round, white to pale yellow nodules were disseminated throughout the liver, resulting in a so-called starry-sky appearance. Similar granulomas were seen in the right caudal lung lobe and small intestinal serosa. A single granuloma in the liver, which differed from the others by its larger size, contained a pair of adult schistosomes. Several hepatic granuloma specimens were used for PCR amplification and sequencing. Use of primers specific for a portion of the Heterobilharzia americana small subunit rRNA gene resulted in amplification of a 487-base pair product that had 100% sequence identity with H americana. CLINICAL RELEVANCE-Severe cases of disseminated granulomas in the liver of horses may result in a liver with a grossly abnormal starry-sky pattern. To our knowledge, this is the first report documenting the association of granulomas with H americana infection along with adult schistosomes in the liver of a horse.