Equine Case Report: Pistol's Porcupine Predicament

Pistol came to us after he had an unfortunate encounter with a porcupine. This run in led to about 50 quills being embedded in his lower front leg. On initial assessment, he was very lame, had a swollen leg, and was running a high fever.

Initial Treatment

The initial task involved the removal of all quills. The patient was sedated, administered Banamine for pain and inflammation, and received a tetanus vaccine. Each quill was meticulously extracted, followed by clipping and cleaning of the leg to ensure none remained. Due to significant swelling and discomfort, a diagnosis of cellulitis, an infection of the skin, was made. Antibiotic treatment was initiated, and a sweat wrap was applied to the leg. Additionally, bloodwork was conducted, including a serum amyloid A (SAA) test.

• SAA is an acute phase protein produced by the liver and elevates in response to inflammation and infection in the body. It rises very quickly in response to these things, allowing us to diagnose and monitor infection levels. It is a test we are able to perform stall side and have results in 10 minutes, making it valuable for making decisions in the field.

•  A normal value is <50

• Pistol’s value were 1,800, indicating significant infection

Further Diagnostics

Despite the administration of antibiotics, Pistol’s leg remained swollen, and he continued to experience fevers. After a few days, the swelling reduced and localized around the tendon area. Given his persistent fever and minimal improvement, we suspected an additional infection alongside cellulitis. Consequently, he was brought to the clinic for further evaluation.

Ultrasound image showing a quill fragment within the medial tendon sheath, indicated by an arrow.

ultrasound of the lower limb revealed the cause: a small fragment of a quill had embedded itself in the soft tissue of his tendon sheath. This resulted in a septic tendon sheath, an infection of the area containing the tendons at the back of the leg. This situation was concerning because infections of synovial structures, such as joints or tendon sheaths, can be life-threatening, potentially causing severe lameness, lasting damage, and sepsis—a widespread infection throughout the body.

In-Clinic Care

Pistol stayed at the clinic with us for five days for more intensive care to manage his infection. His treatments included:

• Tapping the tendon sheath- or using a needle and syringe to sample synovial fluid from the area. This allows us to assess the fluid for color, consistency, and infection. We were even able to test the SAA of the fluid to confirm it was infected!

• Multiple regional limb perfusions

• Aggressive IV antibiotics

• Frequent bandage changes and close monitoring

During his clinic stay, we successfully conducted a series of regional limb perfusions (RLP). This procedure enables the delivery of a high concentration of antibiotics to a specific area of the body—in Pistol's case, his infected tendon sheath. A tourniquet is applied tightly above the treatment area on the leg, and antibiotics are injected into a vein. The tourniquet remains in place for 20 minutes to restrict normal blood flow, allowing the medication to be absorbed in the targeted area. Pistol responded well to the procedure, and we performed an RLP every other day for a total of three treatments.

Fortunately, Pistol responded exceptionally well to the treatments. His swelling diminished, and his comfort consistently improved. Additionally, his SAA levels continued to decrease.

Recovery and Prognosis

Pistol at discharge- happy and sound!!

By discharge, Pistol was walking completely sound and thrilled to head home to his best friend, Lefty. He remained on a course of oral antibiotics and was closely monitored for any recurrence of fever or swelling until his SAA returned to normal. Because of all his progress, his prognosis is excellent, and we’re so happy to see him back to his bright, spirited self!

Written by Dr. Maddy Gehin

11/11/25