Hemorrhagic Gastritis Associated with Renal Failure, Hemoglobinuria, and Isolation of Clostridium perfringens in a Horse

A 3-year-old Quarter Horse mare was presented for acute colic with bright red-black foul-smelling gastric reflux containing long rod-shaped bacteria consistent with Clostridium sp. and red-black urine. The serum creatinine concentration was 5.5 mg/dL (N = 0.9–1.7), and blood urea nitrogen was 41 mg/dL (N = 9–20). At necropsy, the stomach wall was diffusely thickened, hemorrhagic, and edematous. Histopathologically, hemorrhagic necrosis was evident, with numerous colonies of spore-forming rods within the submucosa. Clostridium perfringens was cultured from the stomach contents. Polymerase chain reaction (PCR) genotyping was consistent with type A C. perfringens. Bilaterally, the kidneys were grossly enlarged, diffusely dark red-brown, and congested. The renal tubular epithelium was diffusely, acutely necrotic, with interstitial hemorrhage and massive accumulation of intratubular granular and proteinaceous casts. A diagnosis of massive hemolysis with hemoglobinuria and renal failure due to C. perfringens, type A infection was made. Alpha-toxin–induced intravascular hemolysis occurs rarely in humans and sheep. To our knowledge, this has not been described in horses with clostridial enterocolitis nor in equine clostridial gastritis.