Juvenile Cellulitis in Dogs: A Retrospective Study of 18 Cases ( )

Juvenile Cellulitis in Dogs: A Retrospective Study of 18 Cases (1976 2005) Danny W. Scott*, William H. Miller, Jr. Department of Clinical Sciences, College of Veterinary Medicine, Cornell University Abstract: Juvenile cellulitis was diagnosed in 18 puppies, 3 weeks to 5 months of age. When examined by the Dermatology Service, all puppies had facial (muzzle, lips, eyelids) lesions and enlarged submandibular and prescapular lymph nodes. Eleven dogs (61%) had pinnal lesions and 6 dogs (33%) had widespread skin lesions. Fever and lethargy were present in only 22% and 17%, respectively, of the puppies. Seventeen dogs were cured with immunosuppressive glucocorticoid therapy for 7 to 21 days. No side effects were reported. One mildly affected puppy spontaneously resolved. No relapses were reported. Key words: dog, juvenile cellulites (Jpn J Vet Dermatol 2007, 13 (2): 71 79) Introduction Juvenile cellulitis (JC) is one of the classical canine skin disorders 32). The father of veterinary dermatology Dr. Frank Král first described JC with the term lymphadenitis aposthematosa 13). The etiopathogenesis of JC is unknown. Early writings indicted that the condition was caused by viral infections (especially canine distemper) complicated by secondary bacterial infection (especially Staphylococcus aureus and S. intermedius) 10, 13, 14, 24). Other proposed etiologic factors included allergic reactions (to vaccines, drugs, foods, ascarids, or cow s milk), poor hygiene, poor nutrition, endoparasitism, and stress 10, 25, 29, 31, 39). One article described JC in four dogs with concurrent metaphyseal osteopathy (hypertrophic osteodystrophy) and proposed that JC might be a usual reaction to vaccines containing modified live canine distemper virus 16). However, a consistent association with vaccination has never been reported. In addition, an adverse vaccine reaction would not explain the puppies that develop JC at less than six weeks of age, wherein they have not yet been vaccinated *Correspondence to: Danny W. Scott (Department of Clinical Sciences, College of Veterinary Medicine, Cornell University) Ithaca, New York 14853-6401, USA FAX +1-607-253-3534 E-mail: shb3@cornell.edu

72 Juvenile Cellulitis in Dogs and likely still have high levels of maternal antibodies. Lastly, recurrence of JC following subsequent vaccinations has never been reported. Cultures taken from intact skin lesions, affected lymph 4, 11, 24, 28, nodes and joints are negative for bacteria and fungi 32, 35, 37). Special stains and electron microscopic examination have failed to identify microorganisms in biopsy specimens from affected skin and lymph nodes 4, 9, 11, 28, 32, 35, 37). Affected lymph node tissue was injected intraperitoneally into four 1-week-old puppies and no lesions were produced 28). Given the sterile granulomatous-to-pyogranulomatous nature of JC and the dramatic response to immunosuppressive doses of glucocorticoids, it is currently thought that JC is an immune-mediated disorder 9, 22, 26, 32, 38). Attempts to detect immunological defects in puppies with JC have usually been unsuccessful. Results of serum protein electrophoresis, immunoglobulin (IgA, IgG, IgM) quantitation, and bactericidal assays (neutrophil phagocytosis and killing) have been normal 27, 28, 32). However, in vitro lymphocyte blastogenic responses to phytomitogens (T cell function) were suppressed in association with a serum suppressor factor 3, 32). It appears that JC also may have an inherited component, as (1) certain breeds golden retrievers, dachshunds, Gordon setters, basset hounds, beagles, Labrador retrievers, Brittany spaniels, English pointers, Great Danes, Lhasa apsos, and rottweilers are reported to be overrepresented; 2, 5, 6, 8, 9, 19, 21, 22, 25, 29, 32, 36, 37) and (2) familial occurrence (littermates affected; same dam or sire producing multiple litters with affected puppies) is wellrecognized 5, 6, 27, 28, 32, 37). A retrospective pedigree analysis and prospective breeding trial in one colony of dachshunds supported a hereditary component 27). In a survey of owners and breeders of Gordon setters in the United Kingdom, 45% of the breeders reported having had cases of JC, and the percentage of affected litters increased from 9.1% (1962 to 1985) to 24.4% (1985 1988) 17). In the same survey the age of the dam, the timing of worming and vaccination, litter size, bedding, and feeding practices had no apparent influence on the occurrence of JC in Gordon setters 17). Other breeds reported to have developed JC include mongrel, cairn terrier, weimaraner, Rhodesian ridgeback, Siberian husky, miniature poodle, English springer spaniel, and Chesapeake Bay retriever 4, 16, 20, 24, 26, 28, 37). JC typically occurs in puppies from five weeks to four months of age, with a range of three weeks to nine months 2, 4, 7 9,16, 17, 19, 22, 24, 26, 32, 35 39). Whereas the vast majority of authors report no sex predilection, the United Kingdom survey of Gordon retrievers reported an increased incidence in males 17). From one puppy to two-thirds of the puppies in a litter may be affected 5, 6, 25, 28, 29, 37). JC is reported to be uncommon 9, 17, 30, 32) and to occur most commonly in winter and early spring 7, 13, 14). JC occurs with variable degrees of severity. The abnormality noticed by most owners is an acutely swollen 8, 9, 18, 19, 21 23, face, especially the eyelids, lips, and muzzle 26, 30, 32, 37 39). Physical examination at this time reveals striking submandibular and occasionally prescapular lymphadenopathy. Within 24 to 48 hours, papules and pustules rapidly develop, especially on the lips, muzzle, chin, bridge of the nose, and periocular area. Lesions typically fistulate, drain purulent (often hemorrhagic) exudate, and crust. A marked pustular otitis externa is common, and the pinnae are frequently thickened, edematous, erythematous, and studded with deep-seated pustules. Affected skin is often painful, but not pruritic. About 50% of affected puppies are lethargic. Poor appetite, pyrexia, and joint pain (with or without lameness) are present in up to 25% of affected puppies. Puppies occasionally have concurrent sterile pyogranulomatous-to-granulomatous panniculitis with firm-to-fluctuant subcutaneous nodules that may be painful or fistulate 9, 32). These lesions occur most commonly on the trunk or in the inguinal, prepucial, or perineal areas. Swollen paws have rarely been described 37). Scars (cicatricial alopecia) may occur subsequent to skin lesions, especially those on the face 9, 32). Secondary bacterial infection usually associated with Staphylococcus intermedius can complicate open skin and lymph node 9, 32) lesions. Rarely, lymphadenopathy may precede and be disproportionately severe compared to the skin lesions 16, 28, 37). The current treatment of choice for JC is immunosuppressive doses of glucocorticoids: prednisolone or prednisone at 2 mg/kg q24h PO, or dexamethasone at 0.2 mg/kg q24h PO 4, 11, 16, 18, 19, 21, 22, 26, 30, 32, 35, 37, 38). Glucocorticoid treatment is continued until the disease is in remission, and then an additional seven days. Relapses may be seen if therapy is stopped too soon. Treatment typically is given for two to three weeks. Systemic antibiotics are given if secondary bacterial infection is present. Systemic antibiotics are not effective when given alone 4, 11, 16, 19, 21, 24, 32, 35, 37). Topical therapy such as wet soaks with aluminum acetate or magnesium sulfate is useful for its ability to remove debris, dry, and soothe 19, 26, 32).

Scott, D.W. and Miller, W.H. 73 However, puppies may find restraint and pain distressing, and the resulting struggling and stress can be counterproductive. Synonyms for JC in the veterinary literature include: lymphadenitis aposthematosa, puppy head gland disease, puppy strangles, big head disease, juvenile pyoderma, and juvenile sterile granulomatous dermatitis and lymphadenitis 1, 2, 7, 9, 10, 13 15, 17, 26, 31, 32, 38). Our purpose was to perform a retrospective study on 18 puppies with JC and to compare and contrast our results with those in the veterinary literature. Materials and Methods A retrospective study was conducted on 18 dogs with juvenile cellulitis seen by the Dermatology Service of the Cornell University College of Veterinary Medicine from 1976 to 2005. Medical records were reviewed for the following information: 1. Signalment (breed, age, sex). 2. Season of the year. 3. Duration of disease prior to examination. 4. Concurrent disorders. 5. Laboratory findings. 6. Therapeutic protocols. 7. Total duration of disease with or without treatment. 8. Follow-up period. Results The signalments for 18 dogs with JC are presented in Table 1. Breeds represented included five golden retrievers, two rottweilers, two Irish water spaniels (littermates), two mongrels, and one dachshund, American cocker spaniel, Jack Russell terrier, beagle, border terrier, cairn terrier, and Boston terrier each. There were 12 males and six females. The age at which the condition was first noticed varied from 3 to 35.5 weeks, with 16 of the dogs (90%) being less than four months old. The duration of disease prior to examination by the Dermatology Service was 0.5 to 4 weeks. Fourteen of the 18 dogs (78%) were referred by practicing veterinarians. Fifteen dogs had received prior antibiotic therapy with no improvement (Table 1); five dogs had received prior glucocorticoid therapy (prednisolone or prednisone) with no improvement (Table 1). Where information on littermates Table 1. Clinical Data on 18 Dogs with Juvenile Cellulitis Case Breed Sex Age (weeks) Duration of Disease (weeks) Previous Therapy 1 Dachshund F 9 1 Gentamicin, lincomycin 2 Golden retriever M 8 1 Gentamicin 3 Rottweiler M 9 1 Amoxicillin, gentamicin 4 American cocker spaniel M 8 1 Amoxicillin, prednisolone 5 Mongrel M 18 1 Lincomycin 6 Rottweiler M 16 0.5 7 Golden retriever M 7 0.5 Prednisone, cefadroxil 8 Golden retriever F 10 3 Amoxicillin, amoxicillin clavulanate, prednisone, enrofloxacin 9 Golden retriever M 5 0.5 Prednisolone, cefadroxil 10 Mongrel M 10 3 Amoxicillin, lincomycin, prednisone, cephalexin 11 Golden retriever M 10 1 Ampicillin, gentamicin 12 Beagle M 36 0.5 13 Border terrier F 5 0.5 14 Cairn terrier F 12 1 Amoxicillin, gentamicin 15 Boston terrier M 6 0.5 Amoxicillin clavulanate 16 Irish water spaniel M 11 4 Amoxicillin, cephalexin 17 Irish water spaniel F 11 4 Amoxicillin, cephalexin 18 Jack Russell terrier F 4 1 Amoxicillin clavulanate

74 Juvenile Cellulitis in Dogs was available, two dogs (cases 2 and 9) were known to be the only ones affected, while cases 16 and 17 were littermates. Seven dogs developed their disease in winter (December to February), four in spring (March to May), four in fall (September to November), and three in summer (June to August). The submandibular and prescapular lymph nodes were affected in all dogs, and were noticed to be enlarged from the beginning. Skin lesions began on the face and ears in eight dogs, eyelids in six, ears in two, and face in two (Table 2). At the time of examination by the Dermatology Service, the face (muzzle, lips, eyelids) was involved in all dogs, the ears in 11, and perineal area in four, the paws in two, and neck in one, the shoulders in one, the trunk in one, and the inguinal area in one (Table 2) (Figs. 1 10). Systemic signs included the following: fever in four dogs, lethargy in three, depression in one, poor appetite in one, polyarthritis in one, and generalized lymphadenopathy in three (Table 2). Skin scrapings were negative in all dogs. Skin cytology was performed on all dogs, and revealed pyogranulomatous inflammation with no bacteria (Fig. 11). Cytological examination was also performed on a lymph node aspirate for one dog (case 4: pyogranulomatous inflammation, no bacteria) and a joint aspirate from one dog (case 11: suppurative inflammation, no bacteria). Skin biopsies were performed in two dogs (cases 15, 16) and revealed diffuse pyogranulomatous dermatitis and panniculitis with periadnexal granulomatous dermatitis (Figs. 12 14). Cultures (bacterial, fungal) were performed on skin lesion aspirates in four dogs (cases 3, 8, 15, 16) and were negative. Chemistry panel (cases 2, 7, 11, 12) and urinalysis (cases 2, 11) results were normal. Hemogram values were normal in five dogs (cases 2, 10, 11, 16, 17) and revealed mild leukocytosis, neutrophilia, and monocytosis in three dogs (cases 3, 7, 12). Glucocorticoids were administered by mouth in combination with antibiotics by mouth in 12 of our dogs, and alone in five dogs (Table 2). Nine dogs received dexamethasone (0.2 mg/kg q24h), seven received prednisolone (2 mg/kg q24h), and two received prednisone (2 mg/kg q24h). One dog (case 13) was mildly affected and received no treatment. The total duration of treatment given by the Dermatology Service varied from 7 to 21 days, at which time all treated dogs were cured. No side effects were reported. The dog that received no treatment (case 13) had a total duration of disease of 23 days, prior to spontaneous resolution. Post-cure follow-up information was available for 10 dogs (cases 1, 8, 9, 10, 13, 14, 15, 16, 17, 18), and no relapses were seen in the ensuing 1 month Table 2. Lesion and Therapeutic Data on 18 Dogs with Juvenile Cellulitis Case Distribution of Skin Lesions* Noncutaneous Abnormalities Treatment 1 F, E, N, S Generalized lymphadenopathy Dexamethasone, cefadroxil 2 F, E, Pe Prednisolone, cephalexin 3 F, E Fever Prednisolone, cephalexin 4 F, E, T Dexamethasone, cefadroxil 5 F, E, Prednisolone, cefadroxil 6 F, E, Fever, lethargy Dexamethasone, amoxicillin clavulanate 7 F Fever, depression Dexamethasone, cefadroxil 8 F Dexamethasone, cephalexin 9 F Lethargy Dexamethasone, cefadroxil 10 F Dexamethasone, cephalexin 11 F, E Fever, lethargy, polyarthritis Prednisolone, cephalexin 12 F Poor appetite Prednisone 13 F None 14 F Dexamethasone, cefadroxil 15 F, E, Pe, G Prednisolone 16 F, E, Pe, Pa Generalized lymphadenopathy Prednisolone 17 F, E, Pe, Pa Generalized lymphadenopathy Prednisolone 18 F, E, Pa Prednisolone *F = face; E = ear; N = neck; S = shoulder; Pe = perineum; T = trunk; G = groin; Pa = paws.

Scott, D.W. and Miller, W.H. 75 Fig. 1. Early juvenile cellulitis in a Jack Russell terrier (case Fig. 3. Same dog as in Figure 2. Note purulent-to- 18). Erythema, edema, papules, and alopecia on face hemorrhagic discharge from draining tracts. and pinna. Fig. 2. Typical juvenile cellulitis in a golden retriever (case Fig. 4. Same dog as in Figures 2 and 3. Multiple deep-seated 11). Note symmetrical swellings of muzzle as well pustules on pinna and external ear canal. as pustules, papules, and draining tracts. to 10 years. Six dogs (cases 1, 7, 10, 15, 16, 17) were reported to have permanent facial scars (Fig. 15). Discussion JC is an idiopathic sterile pyogranulomatous or granulomatous dermatitis and lymphadenitis 9, 32). None of our puppies had concurrent diseases, poor nutrition, or poor hygiene. No evidence was found of contagion or zoonosis. The condition appeared suddenly in puppies three weeks to nine months of age, with most puppies being less than four months old. A dermatosis resembling juvenile cellulitis has been reported in a two-year-old dog 12). This dog initially developed otic pruritus (not seen in JC), did not respond to appropriate doses of dexamethasone and triamcinolone (not typical of JC), and slowly recovered after a several week course of cefadroxil given for Staphylococcus intermedius cultured from affected tissues. We do not believe this dog had JC. Although certain breeds appear to have an increased prevalence of JC, any breed or mongrel can probably be affected. We report, for the first time, JC in two Irish water spaniels (littermates), an American cocker spaniel, a border terrier, a Boston terrier, and a Jack Russell terrier. Only one previous study has indicated an increased incidence of JC in males 17). An increased incidence in

76 Juvenile Cellulitis in Dogs Fig. 5. Juvenile cellulitis in a Boston terrier (case 15). Erythema, edema, and alopecia of muzzle and eyelids. Fig. 7. Juvenile cellulitis in an American cocker spaniel (case 4). Note swelling, alopecia, and annular crusts on muzzle and pinna. Fig. 8. Same dog as in Figure 7. Ulcerated subcutaneous nodules (panniculitis) over trunk. Fig. 6. Same dog as in Figure 5. Erythematous papules and plaques in perineal area. males was also found in our study: 67% of the dogs with JC were males, while only 50% of all canine patients examined by the Dermatology Service during the same time period were male. Early literature on JC indicated that it was seen most commonly in winter and early spring 7, 13, 14). In our study 11 of 18 puppies (61%) developed their disease in winter and spring, which has been reported by others 7, 13, 14). The reason for this apparent seasonality is not clear. It may simply be that most puppies in the northern hemisphere are born in the fall and winter. We were unable to find this information for our area. The initial lesions of JC are typically seen on the face and/or pinnae. In our study, skin lesions were initially observed on the eyelids in 33%, and the pinnae in 11%, respectively, of the puppies. Eyelids and pinnae have occasionally been the initial lesion localizations in other reports 16, 24). Six of our puppies (33%) had widespread skin lesions. This has also been recognized in a minority of cases by other authors 16, 25, 35, 37). Generalized lymphadenopathy usually in association with widespread skin lesions was seen in three of 18 (17%) of our puppies, and has been reported by others 16, 37). Multiple paws were affected in two of our puppies, which has previously been reported only once 37). Systemic abnormalities fever (22% of puppies), lethargy (17%), depression (6%), poor appetite (6%), and lameness (6%) were seen less frequently in our study

Scott, D.W. and Miller, W.H. 77 Fig. 9. Chronic juvenile cellulitis in an Irish water spaniel Fig. 12. Juvenile cellulitis (case 16). Skin biopsy specimen. (case 16). Alopecia, edema, erythema, crusts, and Diffuse pyogranulomatous dermatitis and panniculitis draining tracts on face. with marked diffuse edema. H&E stain, 40. Fig. 10. Same dog as in Figure 9. Alopecia, edema, and erythema of paw and distal leg. Fig. 13. Same specimen as Figure 13. Pyogranulomatous dermatitis and panniculitis with marked edema. H&E stain, 100. Fig. 11. Juvenile cellulitis (case 11). Cytological examination of skin lesion. Neutrophils (mostly nondegenerate), macrophages, lymphocytes, and no microorganisms (sterile pyogranulomatous inflammation). Diff- Quik stain, 400. Fig. 14. Juvenile cellulitis (case 15). Skin biopsy specimen. Periadnexal granuloma near sebaceous gland (arrow). H&E stain, 200.

78 Juvenile Cellulitis in Dogs Fig. 15. Healed juvenile cellulitis in two Irish water spaniel littermates (cases 16 and 17). Both dogs have permanent symmetrical scarring (cicatricial alopecia) of face. than previously reported 9, 16, 32, 37). Interestingly, the presence of systemic signs does not necessarily correlate with the severity of the skin lesions. All dogs with fever and lethargy in our study had localized skin lesions (face, pinnae). The differential diagnosis for JC includes angioedema, demodicosis, severe bacterial pyoderma, and adverse cutaneous drug reaction 9, 32). The definitive diagnosis is usually based on history, physical examination, ruling out possible differentials (drug history, skin scrapings, cytological analysis of skin lesions), and corroborative cytological findings from skin lesions (pyogranulomatous inflammation with no microorganisms). Cultures and skin biopsies are not usually performed 9, 19, 21, 32). Mild normocytic, normochromic anemia, as well as mild leukocytosis, neutrophilia, and monocytosis were seen in three of eight puppies (40%) tested in our study. This is consistent with other reports 28, 37). Chemistry panels were normal in the four puppies tested in our study. This is also consistent with previous reports 11, 28, 35). When performed in our study, culture results (negative) and biopsy findings (nodular-to-diffuse pyogranulomatous dermatitis) were consistent with previous reports 9, 28, 32, 37). Fifteen puppies (83%) in our study had received prior antibiotic therapy with either no response or a worsening of their condition. This is consistent with previous reports 4, 11, 16, 19, 21, 24, 32, 35, 37). Five dogs (28%) in our study had also received prior glucocorticoid therapy with appropriate doses of prednisolone or prednisone, but had not responded. These five dogs responded completely to dexamethasone, as has been previously reported 32). The reason for this is not known. The natural duration of untreated JC is largely unknown. Two untreated dogs spontaneously resolved in 49 days 28). Another dog treated with antibiotics alone resolved in 32 days 25). One of our puppies a mildly affected dog spontaneously resolved after 23 days. It is clear that most dogs with JC prior to the advent of glucocorticoid therapy spontaneously resolved 1, 5, 6, 8, 10, 13 15, 25, 29, 31, 36). Regrettably, specifics on duration of disease were not given. While it is probable that early, aggressive glucocorticoid therapy shortens the course of JC, it is clear that it decreases the severity, the discomfort, and the subsequent cicatricial alopecia 9, 32). Recently it has been reported that griseofulvin (14 to 34 mg/kg, q12h, PO) was effective for the treatment of JC in seven puppies 20, 34). Griseofulvin is a fungistatic drug that also has immunomodulatory properties. It is interesting to note that Dr. Král believed that tetracycline and sulfonamides were the two most effective antibiotics in the treatment of JC 13). These two antibiotics also possess immunomodulatory properties 33). JC is reputed to be an uncommon disease 9, 17, 30, 32). In our clinic, JC is rare, accounting for only 0.1% of all the canine dermatology cases seen during a 30-year period. This may reflect the largely referral or second-opinion nature of our practice. References 1) Altman, N.H. 1968. Lymphadenitis aposthematosa in a dog. J. Am. Vet. Med. Assoc. 153: 307 309. 2) Baker, K.P. and Thomsett, L.R. 1990. Juvenile pyoderma. pp. 110 111. In: Canine and Feline Dermatology, Blackwell Scientific Publications, Boston. 3) Barta, O. and Oyekan, P.D. 1981. Lymphocyte transformation in veterinary clinical immunology. Comp. Immunol. Microbiol. Infect. Dis. 4: 209 221. 4) Bassett, R.J., Burton, G.G. and Robson, D.C. 2005. Juvenile cellulitis in an 8-month-old dog. Aust. Vet. J. 83: 280 282. 5) Bower, J. 1968. Treatment of an allergy in puppies. Vet. Rec. 82: 334. 6) Dakin, G.W. 1968. Treatment of an allergy in puppies. Vet. Rec. 82: 335. 7) Donovan, E.F. 1963. Lymphadenitis aposthematosa (puppy strangles). Mod. Vet. Pract. 44: 82 84. 8) Grant, D.I. 1986. p. 174. In: Skin Diseases in the

Scott, D.W. and Miller, W.H. 79 Dog and Cat, Blackwell Scientific Publications, Boston. 9) Gross, T.L., Ihrke, P.J., Walder, E.J., Affolter, V.K. 2005. Juvenile sterile granulomatous dermatitis and lymphadenitis. pp. 327 329. In: Skin Diseases of the Dog and Cat. Clinical and Histopathologic Diagnosis, 2nd ed, Blackwell Science, Ames. 10) Herman, L.H. 1969. Lymphadenitis aposthematosa in a dog. Vet. Med. Small Anim. Clin. 64: 75 76. 11) Hutchings, S.M. 2003. Juvenile cellulitis in a puppy. Can. Vet. J. 44: 418 419. 12) Jeffers, J.G., Duclos, D.H. and Goldschmidt, M.H. 1995. A dermatosis resembling juvenile cellulitis in an adult dog. J. Am. Anim. Hosp. Assoc. 31: 204 208. 13) Král, F. 1957. Lymphadenitis aposthematosa. N. Am. Vet. 38: 375 384. 14) Král, F. and Schwartzman, R.M. 1964. Lymphadenitis aposthematosa. pp. 237 238. In: Veterinary and Comparative Dermatology, J.B. Lippincott Co., Philadelphia. 15) Leveque, J.I. and Leveque, N.W. 1961. Lymphadenitis aposthematosa in the dog. Mod. Vet. Pract. 42: 57 58. 16) Malik, R., Dowden, M., Davis, P.E., Allan, G.S., Barrs, V.R., Canfield, P.J. and Love, D.N. 1995. Concurrent juvenile cellulitis and metaphyseal osteopathy: an atypical canine distemper virus syndrome? Aust. Vet. Practit. 25: 62 67. 17) Mason, I.S. and Jones, J. 1989. Juvenile cellulitis in Gordon setters. Vet. Rec. 124: 642. 18) McKeever, P.J. and Harvey, R.G. 1998. Canine juvenile cellulites. p. 118. In: Skin Diseases of the Dog and Cat, Iowa State University Press, Ames. 19) Medleau, L. and Hnilica, K.A. 2001. Canine juvenile cellulites. pp. 152 153. In: Small Animal Dermatology. A Color Atlas and Therapeutic Guide, W.B. Saunders Co., Philadelphia. 20) Miura, H., Nakamura, T., Shibata, K. and Nagata, M. 2005. Canine juvenile cellulitis successfully treated with griseofulvin in a dog. Jpn. J. Vet. Dermatol. 11: 9 12. 21) Moriello, K.A. and Mason, I.S. 1995. Juvenile cellulites. p. 146. In: Handbook of Small Animal Dermatology, Elsevier Science, Tarrytown. 22) Nesbitt, G.H. and Ackerman, L.J. 1998. Juvenile cellulites (puppy strangles). pp. 153 154. In: Canine and Feline Dermatology. Diagnosis and Treatment, Veterinary Learning Systems, Trenton. 23) Öhlén, B. 1990. p. 50. In: Common Skin Diseases in Dogs and Cats, Schering-Plough Animal Health, Union. 24) Parker, B.N.J. 1968. Treatment of an allergy in puppies. Vet. Rec. 82: 206. 25) Paterson, S. 1998. pp. 262 264. In: Skin Diseases of the Dog, Blackwell Science, Malden. 27) Prieur, D.J. and Hargis, A.M. 1982. A severe form of canine juvenile pyoderma with an inherited component. Fed. Proc. Soc. Exp. Biol. 41: 696. 28) Reimann, K.A., Evans, M.G. and Shalifonx, L.V. 1989. Clinicopathologic characterization of canine juvenile cellulitis. Vet. Pathol. 26: 499 504. 29) Rhodes, J. 1968. Treatment of an allergy in puppies. Vet. Rec. 82: 334. 30) Rhodes, K.H. 2002. Canine juvenile cellulites. pp. 573 575. In: The 5-Minute Veterinary Consult Clinical Companion: Small Animal Dermatology, Lippincott, William & Wilkins, Philadelphia. 31) Schnelle, G.B. 1947. Phlegmonous stomatitis in puppies. N. Am. Vet. 28: 312. 32) Scott, D.W., Miller, W.H. and Griffin, C.E. 2001. Canine juvenile cellulites. pp. 1163 1167. In: Muller & Kirk s Small Animal Dermatology, 6th ed, W.B. Saunders Co., Philadelphia. 33) Scott, D.W., Miller, W.H. and Griffin, C.E. 2001. Sysetemic antibiotics. p. 285. In: Muller & Kirk s Small Animal Dermatology, 6th ed, W.B. Saunders Co., Philadelphia. 34) Shibata, N. and Nagata, M. 2004. Efficacy of griseofulvin for juvenile cellulitis in dogs. Vet. Dermatol. 15 (Suppl.1): 26. 35) Snead, E.C., Lavers, C. and Hanna, P. 2004. A challenging case: a febrile dog with a swollen tarsus and multiple skin lesions. Vet. Med. 99: 940 948. 36) Turner, T. 1968. Treatment of an allergy in puppies. Vet. Rec. 82: 335. 37) White, S.D., Rosychuk, R.A., Stewart, L.J., Cape, L. and Hughes, B.J. 1989. Juvenile cellulitis in dogs: 15 cases (1979 1988). J. Am. Vet. Med. Assoc. 195: 1609 1611. 38) Wilkinson, G.T. and Harvey, R.G. 1994. In: Color Atlas of Small Animal Dermatology. A Guide to Diagnosis, 2nd ed, Mosby-Wolfe Publishing, London. 39) Willemse, T. 1991. pp. 124 125. In: Clinical Dermatology of Dogs and Cats. A Guide to Diagnosis and Therapy, Wetenschappelijke uitgiverij Bunge, Utrecht.