A challenging case: A febrile dog with a swollen tarsus and multiple skin lesions - Veterinary Medicine
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A challenging case: A febrile dog with a swollen tarsus and multiple skin lesions
The condition that these clinicians suspect in this Labrador is considered a late-onset manifestation, even though the dog is only 9 months old.



The dog was discharged on Day 6. At this time, the dog was alert, the preputial swelling had resolved, and the facial pustules had decreased in number and were no longer rupturing. The prescapular lymph nodes were smaller, but there was no appreciable change in the size of the submandibular and inguinal lymph nodes. Evidence of panniculitis was still present, but the right tarsal swelling and lameness had resolved. The dog continued to receive the cephalexin, prednisone, and ophthalmic ointment at the previously stated doses for 10 days. At a 10-day recheck performed by the referring veterinarian, the dog's lesions were dramatically improved, so the cephalexin and ophthalmic ointment were discontinued, and the owners were instructed to slowly taper the prednisone over the next six to eight weeks (i.e. a 25% reduction in the dose every two weeks). Eight weeks after presentation, the dog's skin lesions had completely resolved.


8. A photomicrograph of Figure 7 at a higher magnification showing predominantly epithelioid macrophages and neutrophils (hematoxylin-eosin; bar = 50 m).
Juvenile cellulitis, also referred to as juvenile pyoderma, puppy strangles, and juvenile sterile granulomatous dermatitis and lymphadenitis, is an uncommon disorder primarily reported in puppies between 3 and 12 weeks of age.1 Often, more than one puppy in a litter is affected. The condition has been reported sporadically in many breeds, but golden retrievers, dachshunds, and Gordon setters may be predisposed.1,2 The development of the dermatologic lesions is often preceded by an acute onset of facial swelling with markedly enlarged submandibular lymph nodes.1 This is followed by the rapid development of papules and pustules affecting the face, pinnae, lips, and periocular region. Pustules typically rupture and eventually crust over. A marked painful, pustular otitis externa may also occur.1,3,4 The reactive submandibular lymphadenopathy that often precedes the development of the dermatologic lesions is pronounced, and the lymph nodes may eventually rupture (as likely would have happened in this case) and become fistulous.1

The reactive lymphadenopathy may also be more generalized, as seen in this patient. Half of all affected puppies exhibit lethargy, and 25% are systemically ill, exhibiting anorexia, pyrexia, and joint pain.1,3 The arthritis is characterized by a sterile suppurative reaction.3 Rarely, a sterile pyogranulomatous panniculitis with painful, firm to fluctuant, subcutaneous nodules most commonly occurring on the trunk or in the preputial or perianal region is reported (as was presumptively diagnosed in this patient, based on the cytology results and response to immunosuppression). These nodules may become fistulous, leaving deep draining tracts. In two Shetland sheepdog puppies with juvenile cellulitis, including panniculitis, neurologic signs consistent with spinal cord lesions were also seen.1 Concurrent hypertrophic osteodystrophy has also been reported in three dogs, all of which had been inoculated with a combination vaccine containing live attenuated canine distemper virus 10 to 14 days before the clinical signs developed.5 The authors of this report speculated that in some patients juvenile cellulitis might be an atypical clinical variant of canine distemper virus infection.6 The dog in this report had not received a vaccination in over three months.5 Unfortunately, radiographic examination of this dog's right tarsus was not done to rule out concurrent hypertrophic osteodystrophy.

This case was interesting not only because of the unusual late onset of the condition but also because of the severe systemic manifestations. There is only one other report in the veterinary literature of juvenile cellulitis in an older dog, a 2-year-old Lhasa apso.4 Also, although other cases of systemic involvement (e.g. concurrent arthritis and panniculitis) have been reported,3 it is not typical for dogs to display all the systemic clinical features seen in this case.


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