Durando M M, MacKay R J, Staller G S, Cooper B J, Ginn P E, Meneghetti N
Department of Large Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville 32610, USA.
J Am Vet Med Assoc. 1995 Apr 1;206(7):1018-21.
Septic cholangiohepatitis was diagnosed in an 11-year-old Warmblood gelding with a history of intermittent colic and fever. Klebsiella pneumoniae, susceptible to gentamicin, was cultured from the biopsy specimen. However, treatment with gentamicin was unsuccessful, and histologic examination and bacteriologic culture of a biopsy specimen obtained 3 weeks later revealed progression of the hepatic inflammation and yielded growth of gentamicin-resistant K pneumoniae. At this time, several discrete hyperechoic structures, suggestive of biliary calculi, were seen ultrasonographically. A change in antibiotic treatment was associated with gradual resolution of clinical signs. Five months after initial examination, the horse had a sudden onset of severe right forelimb lameness. The horse responded to treatment with antibiotics and phenylbutazone, but lameness and fever that was unresponsive to treatment recurred 7 months later, and the horse was euthanatized. Necropsy revealed nodules throughout the liver and a mass associated with the right metacarpophalangeal joint. Histologic and immunohistochemical examination revealed carcinomatous infiltration of the liver and metacarpophalangeal joint. The tumor was probably of biliary origin. Carcinoma should be considered in cases of septic cholangiohepatitis unresponsive to antibiotic treatment.
一匹11岁的温血种公马被诊断为化脓性胆管肝炎，有间歇性腹痛和发热病史。从活检标本中培养出对庆大霉素敏感的肺炎克雷伯菌。然而，用庆大霉素治疗未成功，3周后获取的活检标本的组织学检查和细菌培养显示肝脏炎症进展，并培养出对庆大霉素耐药的肺炎克雷伯菌。此时，超声检查发现几个离散的高回声结构，提示存在胆结石。抗生素治疗的改变与临床症状的逐渐缓解有关。初次检查5个月后，这匹马突然出现严重的右前肢跛行。这匹马对抗生素和苯基丁氮酮治疗有反应，但7个月后再次出现对治疗无反应的跛行和发热，随后对其实施了安乐死。尸检发现肝脏布满结节，右掌指关节处有一个肿块。组织学和免疫组化检查显示肝脏和掌指关节有癌浸润。肿瘤可能起源于胆管。对于对抗生素治疗无反应的化脓性胆管肝炎病例，应考虑癌症的可能。
