Round Two!! Pharyngeal Phythiosis

Figure 1

The endoscopic image in Figure 1 is from a middle aged quarter horse that presented for abnormal noise during exercise. The entire pharynx is obstructed by multiple granulomas.  Initial biopsy results were consistent with pythiosis and the gelding was treated with systemic anti-fungal medication for several months. 

Figure 2

Recheck endoscopy after 45 days revealed a significant improvement (Figure 2) ; however, treatment was discontinued prematurely and a final endoscopy was not performed.

Figure 3

Over 1 year after the initial presentation, the abnormal noise returned along with bloody nasal discharge. The pale yellow nodules have increased in size and number. Multiple small yellow granuoles are noted through out the pharynx and there is evidence of mild bleeding. The horse will again be treated with systemic anti-fungal medication. A follow up exam to follow!!