The puppy was discharged on 2.2 mg/kg prednisolone PO Q 24 H and 30 mg/kg griseofulvin PO Q 12 H with food. Special stains were negative for infectious agents. Histopathologic evaluation identified severe, chronic, multifocal coalescing pyogranulomatous panniculitis with fibrosis, diffuse hyperplasia, and mild acute focal periadnexal dermatitis.
#Adolescent puppy muzzle skin#
Skin biopsies were obtained with the patient under local anesthesia with 2% lidocaine. Histopathologic confirmation was important in this case because of the apparently incomplete response to therapy. The predominant inflammatory cell in juvenile cellulitis, characterized by light and electron microscopy and immunohistochemical staining, is an epithelioid macrophage. The diagnosis is confirmed by histopathologic evaluation but is commonly made on the basis of clinical appearance. Pyrexia, anorexia, sterile suppurative painful arthritis, and an inflammatory hemogram can occur. Superficial cutaneous flora can be cultured from open, draining lesions ( Figure 1). Pustules and lymph nodes are usually sterile when cultured. Lymphadenomegaly, most commonly mandibular and superficial cervical, can be distant from the affected skin sites and is often painful. The eyelids, pinnae, lips, chin, muzzle, paws, abdomen, thorax, vulva, prepuce, and anus can be affected with lesions that fistulate, drain, and crust. It is most common in dogs younger than 4 months of age but is occasionally reported in dogs up to 4 years old.
Juvenile cellulitis is a progressive, granulomatous, pustular disorder of puppies. The diagnosis was not confirmed, which is especially important when response to therapy is problematic.D. Initiation of immunosuppressive therapy was delayed, and therapy was discontinued too rapidly.C. The dose of prednisone was not immunosuppressive.B. Gait was normal.Īsk Yourself.This puppy was treated with appropriate drugs for the presumptive diagnosis of juvenile cellulitis. The abdomen was relaxed with no masses or organomegaly.
The oral cavity was normal with deciduous dentition and mild brachygnathia. The mandibular lymph nodes were enlarged and painful. Pustules were present on the medial pinnae. Marked lichenification, crusting, alopecia, and hyperpigmentation were present on the periocular, muzzle, and ventral abdominal skin. Physical examination identified lethargy, body condition score 7/9, and normal vital signs. One week later, new cutaneous lesions were noted by the owner, prompting referral to the Veterinary Medical Teaching Hospital. She improved clinically after 10 days, the prednisone was tapered to 5 mg PO Q 48 H. After 4 days of hospitalization for IV fluid and cefazolin therapy, the patient was discharged on cephalexin (20 mg/kg PO Q 12 H) and 15 mg prednisone PO Q 12 H. A hemogram showed mild anemia (hematocrit 28%, regenerative) chemistry panel changes were typical for her age. Five days later, she was anorexic and febrile. At that time, the patient was additionally given 5 mg prednisone PO Q 12 H. A week later, the cutaneous lesions progressed to involve the ventral thorax and inguinal regions, and mandibular lymphadenomegaly was noted. Amoxicillin/clavulanic acid (14 mg/kg PO Q 12 H) was dispensed. Cytologic evaluation of a pustule identified neutrophilic inflammation. The puppy had 9 unaffected littermates, was fed commercial growth-formula kibble, and was unvaccinated. At 6 weeks of age, the puppy was examined by the referring veterinarian for pustules on the eyelids and inner pinnae.
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