A 16 year old Thoroughbred gelding was presented to the Cornell University Equine Hospital for evaluation ofepistaxis and weight loss. In February 2014, the patient had increased upper airway noise and respiratory effort, which responded to antibiotics and steroids. On 7 /20/14, epistaxis and increased respiratory effort were noted and the patient was referred to Cornell. On presentation, the patient was in shock with hyperemic mucous membranes, tachycardia, dyspnea, and frothy blood was seen f om both nostrils. Bloodwork showed severe dehydration, inflammatory leukogram, hypoalbuminemia, and increased liver enzymes. On endoscopy frothy blood was confirmed coming from the trachea. Thoracic x-rays and ultrasound demonstrated severe pulmonary infiltrative disease. Euthanasia was elected and a necropsy was performed, showing chronic nodular fibrotic interstitial pneumonia, consistent with equine multinodular pulmonary fibrosis (EMPF). EMPF has been associated with equine herpesvirus 5 infection.