Intestinal and mesenteric lymphangitis mimicking arteritis in a cow with paratuberculosis

Paratuberculosis is a chronic infectious disease of ruminants caused by Mycobacterium avium subsp. paratuberculosis (MAP). MAP is transmitted primarily through ingestion of contaminated feces, milk, or water and establishes persistent infection within intestinal macrophages by evading host immune defenses. Typical lesions include granulomatous enteritis, lymphangitis, and lymphadenitis. Lymphangitis mimicking arteritis has not been reported in bovine paratuberculosis, to our knowledge. Here, we describe a case of paratuberculosis in a 2-y-old Angus cow that was found dead. Gross changes consisted of red contents in the ileum and streaks of blood in the feces. Histologic examination revealed granulomatous enteritis with abundant intralesional acid-fast bacilli and marked inflammation of intestinal and mesenteric vessels that histologically resembled arteritis. Because arteritis is characteristic of malignant catarrhal fever (MCF), PCR testing was performed and was negative for gammaherpesvirus. MAP infection was confirmed by Ziehl-Neelsen stain and real-time PCR assay. Verhoeff-van Gieson stain revealed a complete absence of inner and outer elastic laminae, supporting a lymphatic rather than arterial origin. Endothelial cells had no immunolabeling for Prox1, a lymphatic endothelial marker, suggesting that it may not be reliably detectable in bovine tissues or that the antibody used lacks cross-reactivity with bovine Prox1. Our findings of chronic lymphangitis initially mimicked arteritis on histology. We emphasize that recognizing this phenomenon is critical to avoid misdiagnosis and highlight the limitations of Prox1 immunohistochemistry in bovine lymphatic vessels.