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Juvenile Cellulitis

Juvenile Cellulitis in a young Staffordshire Bull Terrier

Filippo De Bellis DVM Cert VD DipECVD MRCVS RCVS and European Specialist in Veterinary Dermatology

Species, Breed, Age, Sex

Dog, Staffordshire Bull Terrier, 3 months, intact female.

Owner’s Complaint

Acute onset of facial swelling, crusts and sores on the muzzle, eyelids, ear pinnae and inguinal areas. The owner reported first swelling of the face and ocular discharge two weeks previously, followed by numerous crusting and exudative lesions on the muzzle, periorbital areas and pinnae. No dogs and cats were in regular contact. A vaccination had been done 8 months previously. Previous treatment had included cefalexin (27 mg/Kg twice daily for five days followed by amoxicillin clavulanic acid 17mg/Kg twice daily for seven days), ocular applications of fucidic acid twice daily for three days and oral prednisolone 0.25mg/kg once daily for three days, without benefit.

Physical Examination

The dog weighed 28Kg and on general examination peripheral lymphadenopathy and mild bilateral conjunctivitis were noted. Pyrexia was mild (39.3).

Dermatological examination revealed bilateral periocular alopecia, swelling of the eyelids, mild crusting and mucopurulent ocular discharge with presence; papules were present at the lateral cantus of the right eye. The dorsal and lateral muzzle, the lips and the chin appeared moderately oedematous and showed severe papular, pustular, erythematous dermatitis with presence of loose crusts and exudate (Figure 1). The medial aspects of both pinnae showed oedema and crusting accompanied by purulent discharge.

Figure 1. Alopecia, papular dermatitis and crusting involving the periocular areas and the muzzle. Oedema of both pinnae.

Differential Diagnoses

Juvenile cellulitis, deep staphylococcal pyoderma, demodicosis, dermatophytosis (but not typically presenting with peracute onset); angioedema. Cutaneous drug reaction was considered less likely due to the absence of previous drug exposure.

Laboratory Tests

  • Multiple skin scrapings and hair plucks mounted in liquid paraffin and examined using a light microscope – no evidence of ectoparasites and/or arthrospores.
  • Cytology from exudative lesions stained with modified Wright stain (Diff-Quick) – numerous non-degenerate neutrophils, small numbers of degenerate neutrophils; macrophages (Figure 2).
  • Fine needle aspirate cytology from the left pre-scapular lymph node stained with modified Wright stain (Diff-Quick) – large numbers of degenerate neutrophils and macrophages.
  • Histopathology from lesions – multiple confluent granulomas and pyogranulomas comprising epithelioid macrophages and neutrophils

Figure 2. Photomicrograph of an impression smear from exudative lesion. Note the numerous neutrophils and macrophages consistent with pyogranulomatous inflammmation. (x 1000 magnification).

Diagnosis

The history, the nature and distribution of the skin lesions, the laboratory findings and the lack of response to the antibiotic therapy, were consistent with a diagnosis of juvenile cellulitis (juvenile sterile granulomatous dermatitis and lymphadenitis).

Prognosis

Normally good when appropriate treatment is established.

Treatment

Prednisolone at an immune-suppressive dose (2 mg/kg once daily) was initiated and maintained for two weeks; this was reduced to 0.5 mg/kg daily for three days, on alternate day basis for other three days and then discontinued due to marked reduction in severity and extent of the lesions. Fucidic acid eye ointment twice daily to both eyes was continued for two weeks.

Re-inspections and Final Outcome

Good improvement was noted after one week (Figure 3) of treatment and marked reduction of the lesions with minimal crusting was achieved after two weeks (Figure 4). Total resolution, with some residual scarring, was evident one month later. On a telephone update 14 months later, the owner reported no relapse.

Figure 3. One week follow up: reduced oedema; alopecia and residual crusting.

Figure 4. Two-week follow up: there is partial hair re-growth in the periocular area but muzzle alopecia remains a prominent presenting sign.

Discussion

Canine juvenile cellulitis (CJC) is an uncommon pustular and granulomatous disease affecting mainly the face, pinnae and lymph nodes, seen usually in puppies. However, there are rare reports of dermatoses resembling CJC in adult dogs. This condition has been described with increased occurrence in some breeds (Golden retriever, Dachshund, Gordon setter), but a predisposition in Staffordshire bull terrier has not been reported to the author’s knowledge.

The aetiology and pathogenesis of CJC are unknown; an infectious aetiology has been considered but not demonstrated, and the prompt response to high doses of oral prednisolone supported a non-infectious aetiology in this case. Causative link with a vaccine against distemper virus, adenovirus and parainfluenza virus has also been suggested. The fulminant onset is a typical characteristic of CJC.

Commonly the initial feature is acute swelling of the face, especially on the eyelids, lips and muzzle, with submandibular lymphoadenopathy. Within 24 to 48 hours papules, pustules and crusting develop rapidly. At presentation this dog showed typical cutaneous lesions usually appearing on the head (muzzle, pinnae, and periocular areas); the inner aspects of the pinnae is commonly oedematous and shows presence of crusting and purulent exudate, as in this case; additionally, involvement of the feet, abdomen and thorax, preputial and perianal areas has been reported. Secondary bacterial infections are possible but were not present in this case; lymphoadenopathy was present but pyrexia and depression were not noted as these, along with joint pain, are inconsistent clinical signs.

The clinical differential diagnoses of CJC in this case included mainly deep pyoderma, demodicosis and adverse drug reaction; in early stages, when papules and pustules are absent, it has also to be differentiated from angioedema, but this was not consistent with this dog.

Therapy of CJC requires immune-suppressive doses of glucocorticoids (prednisone or prednisolone at 2 mg/Kg), to be administered until remission of the clinical signs is achieved (usually 10-14 days). If there is cytological evidence of secondary bacterial infection, systemic antibiotics should be given. This dog responded remarkably well to large doses of prednisolone whereas prior antibacterial treatment alone had minimal effect.

Prognosis is generally good, although relapses after discontinuation of treatment have been reported [6]. This dog was successfully managed, relapses were not reported during a period of 14 months and the only sequel was minimal residual scarring alopecia.

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