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Juvenile Cellulitis



AUTHOR: JOCELYN. WELLINGTON



EDITOR MANON. PARADIS



BASIC INFORMATION image



DEFINITION


An uncommon vesiculopustular to granulomatous skin disease primarily affecting dogs < 4 months old. The pinnae, face, and submandibular lymph nodes are typically involved.



SYNONYMS


Juvenile sterile pyogranulomatous dermatitis and lymphadenitis, puppy strangles, juvenile pyoderma



EPIDEMIOLOGY



SPECIES, AGE, SEX


Young puppies of either sex between 3 weeks and 4 months old are typically affected, although confirmed cases in young adults have been rarely reported. One or more puppies in the same litter may be affected.



GENETICS & BREED PREDISPOSITION


Many breeds, including mixed breeds, may develop this disease, but some breeds appear predisposed (e.g., golden retrievers, dachshunds). A hereditary component is proposed. The exact mode of inheritance has not been established.



CLINICAL PRESENTATION



HISTORY, CHIEF COMPLAINT


Early in the course of the disease, an affected puppy develops an acutely swollen face, in particular the muzzle, lips, and eyelids. Marked submandibular lymphadenopathy is usually present even in the absence of cutaneous lesions.



PHYSICAL EXAM FINDINGS



• Acute swelling of face noted initially.

• Within 24-48 hours, vesicles and pustules appear around mouth, eyes, and muzzle. Lesions rapidly develop into a serous to purulent exudative dermatitis with or without fistulation.

• Serous to purulent bilateral otitis externa with edematous pinnae is common.

• Marked regional (submandibular and prescapular) to diffuse lymphadenopathy is common. Submandibular lymphadenopathy may occur as only clinical abnormality.

• Fistulation of affected lymph nodes is variable.

• Affected skin is frequently painful but rarely pruritic.

• Rarely, sterile subcutaneous nodules with or without fistulation develop on the trunk, preputial, or perineal regions.

• Approximately 50% of puppies are lethargic. Anorexia, pyrexia, and lameness (sterile suppurative arthritis) are inconsistent findings.


image JUVENILE CELLULITIS Typical lesions in a 9-week-old rottweiler with edematous eyelids and papules, pustules, and swelling of the muzzle.

(Courtesy Dr. J. Wellington.)



ETIOLOGY AND PATHOPHYSIOLOGY



• The etiology and pathogenesis of juvenile cellulitis are unproven; immune dysfunction is suspected.

• Bacterial invasion is not considered to be the primary cause. Any evidence of infection usually reflects secondary pyoderma.


DIAGNOSIS image



DIAGNOSTIC OVERVIEW


The diagnosis is based almost entirely on signalment, history, and physical exam, with cytologic examination of smears for support and skin scrapings to rule out demodicosis. Juvenile cellulitis should be suspected when a puppy presents with an acutely swollen face, especially the eyelids, lips, and muzzle, edematous pinnae, and submandibular lymphadenopathy. The rapid development of papules, pustules, and serous crusts on the facial and pinnal lesions further supports the diagnosis.



DIFFERENTIAL DIAGNOSIS



• Angioedema: vaccine reaction or insect bite reaction

• Deep pyoderma/muzzle folliculitis

• Demodicosis

• Drug eruption (cutaneous drug reaction)


INITIAL DATABASE



• Impression cytologic analysis of pustule: numerous neutrophils and macrophages (pyogranulomatous inflammation) without bacteria

• Skin scrapings: negative for Demodex mites


ADVANCED OR CONFIRMATORY TESTING


These additional diagnostic tests may be performed but are rarely required:


• Anaerobic or aerobic bacterial culture and sensitivity: usually sterile

• Skin biopsy: multiple discrete or confluent granulomas and pyogranulomas composed of nodular clusters of large epithelioid macrophages with variably sized neutrophilic centers

• Lymph node aspirate: pyogranulomatous lymphadenitis


TREATMENT image



TREATMENT OVERVIEW


Early and intensive immunosuppressive systemic therapy with predniso(lo)ne or dexamethasone is indicated to prevent secondary scarring. Concurrent systemic antibiotics are recommended if secondary pyoderma is found cytologically or marked fistulation is present.



ACUTE GENERAL TREATMENT



• Prednisone or prednisolone (2 mg/kg PO q 24 h, or total dose can be divided q 12 h) until lesions resolve (approximately 1-4 weeks), then reduce to 2 mg/kg PO q 48 h for 2 weeks, then taper off prednisone over the next 2-3 weeks.

• Some dogs respond better to dexamethasone (0.2 mg/kg PO q 24 h). Gradually taper dosage (similar to prednisone).

• Bactericidal antibiotics for 3-4 weeks required if cytologic or clinical evidence of secondary pyoderma present.
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Jul 24, 2016 | Posted by in SMALL ANIMAL | Comments Off on J

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