Photodermatitis and ocular changes in nine horses after ingestion of wild parsnip (pastinaca sativa)

Abstract

Background: Primary photosensitization rarely occurs in horses and can easily be misinterpreted. Descriptions of the disease in horses after ingestion of parsnip are lacking. The aim of this case series was to describe the dermatological and ocular changes due to photosensitization and to raise awareness of parsnip being a possible aetiologic agent.

Case presentation: Nine horses from three different stables in Berlin and Brandenburg, Germany, presented variable degrees of erythema, scaling, crusting and necrosis of unpigmented skin at the head and prepuce. Horses were of different breeds with a median age of 15 ± 5.9 years. A mild leukocytosis was diagnosed in 1/9 horses at admission. Analyzed liver enzymes were within the reference ranges in all horses. Ocular changes were diagnosed as follows: blepharitis (3/9), conjunctivitis (7/9), corneal edema without additional signs of keratitis and/or uveitis (2/9), corneal edema with signs of uveitis (1/9) and photophobia (4/9). One horse developed a fluorescein positive corneal erosion. Skin biopsy (1/9) revealed a moderate to severe acute, eosinophilic and lymphocytic dermatitis with dermal edema and vasculitis. All stables housing these patients fed hay from the same distributer. Analyzed hay samples showed high contents of wild parsnip (plants, seeds, roots). Wild parsnip is widespread in Europe and contains furocoumarins, a family of photodynamic pigments, which may cause primary photodermatitis, keratoconjunctivitis and uveitis. Horses were treated according to severity of clinical symptoms systemically with flunixine meglumine (1.1 mg/kg BW 1-2x/day) or prednisolone (1 mg/kg BW 1x/day). Topically, either gentamicin (3x/day), dexamethasone (2-3x/day) and/or atropine (1x/day) were used. Skin care was provided with almond oil or dexpanthenol (2x/day). All horses were kept in a dark environment or were treated with sunscreen and facemasks. Duration of treatment varied from 6-30 days (median 11.3 days).

Conclusion: Ingestion of wild parsnip (Pastinaca sativa) can induce primary photosensitization with dermatitis and ocular injury in horses. In times of extreme weather, hay may alter in botanical composition, resulting in high amounts of uncharacteristic plants causing novel problems.

Keywords: Bergapten; Cornea; Edema; Erythema; Furocoumarins; Intoxication; Ocular changes; Parsnip; Photosensitization; Sunburn.

Fig. 1

Horse 1 at admission (day 0) showing erythema, crusting and blistering of the unpigmented skin at the head and prepuce

Fig. 2

First skin biopsy of horse 1 with detection of acanthocytes. Hematoxylin and eosin (HE)

Fig. 3

Second skin biopsy of horse 1. The lesion pattern and the lack of acanthocytes led to the suspected diagnosis of hypersensitivity reaction type I. HE

Fig. 4

Horse 1 at day 28 without clinical signs of phytophotodermatitis

Fig. 5

Horse 3 showing photophobia, depression, and dermatitis at admission (day 0)

Fig. 6

Horse 2 with marked corneal edema and corneal lesions on day 3. Mydriasis is due to the treatment with atropine eyedrops

Fig. 7

Horse 3 showing moderate corneal edema at admission (day 0) and mild edema at day 24. There is slight red discoloration in the ventral aspect of the cornea, resulting from hyphema

Fig. 8

Parsnip (Pastinaca sativa) found in a hay sample from one of the stables