A seven-year-old Standardbred gelding presented to the Cornell University Equine and Farm Animal Hospital with a one month history of intermittent fevers and anorexia which was finally diagnosed as strangles after the guttural pouches were visualized by endoscopy and a sample was cultured. He was treated for strangles by his primary care veterinarian and improved. However, the intermittent fevers returned and the horse was referred to determine if he had an internal abscess.

On presentation, the gelding was bright, alert, and responsive with a mildly elevated temperature and pulse rate. A large firm swelling in his throatlatch region was noted. The rest of his physical examination was unremarkable. A hemogram revealed a mild anemia and leukocytosis. Ultrasound of the large swelling showed an abscessed cranial cervical lymph node. Guttural pouch and abscess samples were positive for Streptococcus equi subspecies equi on both culture and PCR, confirming the diagnosis of strangles. While establishing drainage of the abscess, the maxillary vein was inadvertently lacerated. The vein was repaired and subsequently thrombosed. The patient responded well to supportive care with intravenous fluids, antibiotics, and anti- inflammatories.