Definition

• Juvenile cellulitis, also known as puppy strangles, sterile granulomatous dermatitis, and lymphadenitis, is a relatively uncommon immune-mediated condition affecting young dogs. It typically manifests in puppies under six months of age, though rare cases have been reported in young adult dogs up to four years old.

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Etiology

• The exact cause of juvenile cellulitis remains idiopathic, but it is considered to have an immune-mediated component, where the puppy's immune system mistakenly targets its own skin and tissues.

  • Hereditary Component: Some dog breeds are more predisposed to developing juvenile cellulitis, notably Golden Retrievers, Dachshunds, and Gordon Setters.

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Clinical Presentation

• Initial Signs:

  • The disease often presents with acute facial and muzzle swelling, which may rapidly progress to raised pustules on the face, ears, and muzzle. These pustules can rupture, resulting in crusting and scabbing.

  • In severe cases, particularly around the eyes, permanent cosmetic scarring may occur, though this does not affect the dog’s functional quality of life.

• Progression:

  • If untreated, the lesions may spread to other parts of the body, including the paws, anus, and vulva.

  • Swelling of the submandibular lymph nodes (under the jaw) is common and may become painful. As the disease progresses, the affected lymph nodes may rupture and drain, leaving behind oozing tracts.

• Systemic Signs:

  • Affected dogs are typically systemically unwell:

    • Lethargy (affecting ~50% of cases)

    • Anorexia

    • Fever (dogs may feel warm to the touch)

    • Joint pain or lameness may occur in less frequent cases.

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Diagnostic Approach

1. Differential Diagnosis:
   Juvenile cellulitis is uncommon, so it may not be the first consideration when a puppy presents with skin lesions. Common differentials include mange (caused by mites) and ringworm (fungal infection), which can have similar clinical signs.

   • Skin Scrapings: To rule out demodicosis or sarcoptic mange.

   • Fungal Culture: To exclude dermatophytes (ringworm).

2. Further Testing:
   Once more common conditions are ruled out, additional diagnostic tests should be performed:

   • Skin Cytology: A superficial skin sample can be obtained via acetate tape impression or a slide impression to examine for inflammatory cells, bacteria, or yeast.

   • Skin Biopsy: A full-thickness biopsy is recommended for confirmation. Histopathology will typically reveal granulomatous inflammation and sterile pustules, characteristic of juvenile cellulitis.

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Treatment

• Immunosuppressive Therapy:
  Given the immune-mediated nature of juvenile cellulitis, prednisone (a corticosteroid) is the mainstay of treatment.

  • Typically administered at a high dose initially, with a gradual taper over a period of several weeks.

  • Side Effects: Increased thirst, urination, and appetite. Long-term use may also lead to other complications such as GI upset, weight gain, or infections.

• Antibiotic Therapy:
  Although juvenile cellulitis is not caused by bacteria, secondary bacterial infections often develop in the open skin lesions. Treating these secondary infections with broad-spectrum antibiotics helps reduce inflammation, promotes healing, and relieves discomfort. Common choices include cephalosporins or clindamycin, depending on culture results.

• Other Immunosuppressive Drugs:
  In cases where prednisone is ineffective or poorly tolerated, alternative immunosuppressive drugs (e.g., cyclosporine, azathioprine) may be considered.

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Prognosis

• Resolution with Treatment:
  Juvenile cellulitis typically responds well to treatment, with most cases resolving completely after a course of steroids.

  • One treatment course is often sufficient for full resolution.

  • In rare cases, if the disease recurs upon tapering steroids, long-term therapy may be necessary.

• Recurrence:
  While uncommon, the condition may recur as prednisone is tapered. However, with appropriate therapy, long-term control is achievable, and most dogs make a full recovery without lasting effects beyond potential cosmetic scarring.

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