Use of extracorporeal hemoperfusion therapy in an adult horse with Clostridioides difficile colitis and severe systemic inflammatory response syndrome.
Authors: Hobbs Kallie J, Le Sueur Andre N V, Hallowell Kimberly, Martin Emily, Sheats Mary Katherine, Ueda Yu
Journal: Journal of veterinary internal medicine
Summary
# Editorial Summary An 8-year-old Quarter Horse presented with acute *Clostridioides difficile* colitis complicated by severe systemic inflammatory response syndrome (SIRS) characterised by tachycardia, tachypnea, fever, neutropenia and hyperlactatemia, which presented a therapeutic challenge because concurrent acute kidney injury precluded standard anti-inflammatory interventions such as flunixin meglumine and polymyxin B. The clinical team employed extracorporeal hemoperfusion therapy—a blood purification technique that removes inflammatory mediators and bacterial endotoxins—administered twice within 48 hours of SIRS onset. Physical examination parameters improved following treatment, including stabilisation of heart rate, respiratory rate and mucous membrane colour, demonstrating the potential for this modality to interrupt the inflammatory cascade when conventional pharmacological options are contraindicated. Although the horse ultimately required euthanasia due to laminitis development after four days, these findings warrant further investigation into extracorporeal hemoperfusion as an adjunctive therapy for managing severe sepsis and SIRS in equine patients, particularly in cases where renal compromise limits access to traditional anti-endotoxic treatments. For practitioners managing medically complex colitis cases, this case illustrates an emerging tool for consideration when standard protocols cannot be safely employed due to concurrent organ dysfunction.
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Practical Takeaways
- •Extracorporeal hemoperfusion may be a viable adjunctive option for severe SIRS/sepsis in horses when conventional anti-inflammatory therapies are contraindicated due to concurrent organ dysfunction.
- •C. difficile colitis can present as a peracute condition with life-threatening systemic inflammatory sequelae requiring intensive multimodal treatment approaches.
- •Even when acute systemic signs stabilize, secondary complications such as laminitis remain a significant mortality risk in horses with severe infectious colitis.
Key Findings
- •Extracorporeal hemoperfusion therapy was performed twice within 48 hours of severe SIRS onset with stabilization of physical examination variables.
- •The horse presented with peracute C. difficile colitis manifested by positive fecal PCR, tachypnea, tachycardia, fever, neutropenia, altered mucous membrane color, and hyperlactatemia.
- •Concurrent acute kidney injury precluded use of standard anti-inflammatory treatments including flunixin meglumine and polymyxin B due to nephrotoxicity concerns.
- •The horse was euthanized after 4 days due to laminitis despite stabilization of SIRS parameters.