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Juvenile Cellulitis

William Oldenhoff, DVM, DACVD, Madison Veterinary Specialists in Monona, Wisconsin

Dermatology

|June 2020

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In the literature

Inga A, Griffeth GC, Drobatz KJ, Goldschmidt KH, Mauldin EA. Sterile granulomatous dermatitis and lymphadenitis (juvenile cellulitis) in adult dogs: a retrospective analysis of 90 cases (2004-2018). Vet Dermatol. 2019;30:302-303.


FROM THE PAGE…

Juvenile sterile granulomatous dermatitis and lymphadenitis (SGDL) is an uncommon idiopathic sterile inflammatory disease most commonly seen in puppies and referred to as juvenile cellulitis or puppy strangles. Classic clinical features include facial swelling and pustular dermatitis of the periocular skin, pinnae, and muzzle. Lesions can be less common elsewhere. Disease typically affects younger dogs ranging from a few weeks to a few months of age. There have been a couple reports of the disease developing in older dogs, but this is the first extensive case series examining SGDL in adult dogs.

This case series included 90 dogs with biopsy results consistent with SGDL. The median age of onset was 3.54 years, although ages ranged from 1 to 11.4 years. Clinical signs on presentation were found to be similar to those of young dogs, with lesions consisting primarily of edema, ulceration, erythema, crusting, and pustules, primarily of the periocular skin, muzzle, lips, and pinnae. Lesions were also observed on the perianal/genital area and other areas; lymphadenopathy was noted in 33.3% of cases. Systemic signs included lethargy, fever, and hyporexia. All dogs that had drug treatment records available (35/90) were treated with systemic glucocorticoids. Mean glucocorticoid dose, given as prednisone equivalent, was 1.23 mg/kg/day. Antibiotics were frequently coadministered, likely for secondary infection. Median treatment duration was 60 days (range, 20-1825 days), and median time to remission was 28 days. Remission was maintained in 19/30 dogs for which remission status was known. Relapse was noted in 11 of these 30 dogs.


… TO YOUR PATIENTS

Key pearls to put into practice:

1

Despite being known as juvenile cellulitis and puppy strangles, SGDL is not just a disease of puppies. Adult and geriatric animals can be presented with this disease; SGDL should be on the differential diagnosis list for dogs of all ages.

2

Immunosuppressive doses of steroids are the treatment of choice for SGDL, regardless of patient age. Once remission is achieved, steroids should be tapered and eventually discontinued. Most patients with SGDL can be successfully weaned from steroid therapy, although recrudescence is not uncommon.

3

Biopsy remains the best way to achieve definitive diagnosis. Although SGDL can display a classic clinical presentation, biopsy is required to rule out other diseases, which is critical in older patients, as this is a less common presentation of SGDL. Definitive diagnosis is necessary prior to initiating therapy with immunosuppressive doses of steroids.

For global readers, a calculator to convert laboratory values, dosages, and other measurements to SI units can be found here.

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