by Dr. Abigail Roeters
Let me introduce you to a little golden retriever puppy named Greg. Greg originally presented to our clinic for a routine puppy physical exam after being adopted by his owners from a breeder in Wisconsin.
On his first physical exam Greg had very significant ear infections in both ears with lots of smelly discharge, redness and inflammation. I also noted that he had some crusting along the bridge of his nose, under his chin and that his lymph nodes located just behind his jaw (submandibular lymph nodes) seemed to be a bit larger than normal. I had discussed with the owners that the enlarged lymph nodes could be due to the severity of the ear infections he was experiencing but that they needed to keep a close eye on him because of his enlarged lymph nodes. When puppy’s lymph nodes are swollen in that location we get concerned about Juvenile Cellulitis also known as “Puppy Strangles”.
What is Juvenile Cellulitis you ask? This is a disease that is usually specific to puppies 3 weeks to 4 months old, but can rarely occur in older pets. Unfortunately there has not been a specific cause identified but it is speculated to arise from dysregulation of the immune system. It causes facial swelling, severe skin inflammation and crusting as well as enlarged lymph nodes. It is very common within 24 hours of the lymph nodes being enlarged that puppies will develop pustules that will rupture and become crusted specifically on the face and ears. Skin biopsies can give a definitive diagnosis but commonly these specific clinical signs being noted as well as response to medical treatment can yield a positive diagnosis. The core of treatment is using immunosuppressive doses of steroids and treating secondary bacterial infections with oral antibiotics, medicated shampoos and topical ointments and sprays. Regular rechecks are important to track progress and determine if any changes to treatment plans need to be made.
Back to Greg! At Greg’s first visit we cleaned out his ears with an ear cleaner and started him on a topical ear drop to start treating his ear infections. I also dispensed an oral antibiotic to help clear up the crusting and scabbing that was noted on his muzzle (nose). I pointed out to the owners all the locations on Greg’s body where his lymph nodes that can be felt so that they would be able to monitor at home. If they were noticing that his lymph nodes were getting larger or that his ear infection or skin infection were getting worse they needed to call and recheck sooner than 1 week.
Unfortunately the next day the owners noted that Greg’s ears looked worse and saw more discharge in his ears. They also noted that the crusting and scabbing on his face got dramatically worse over night so they called to have Greg re-evaluated. When Greg was evaluated that day his ear infections had gotten significantly worse, the muzzle of his nose was extremely swollen with pustules and discharge and his submandibular lymph nodes had gotten significantly larger. At this point he was diagnosed with suspected puppy strangles and an immunosuppressive dose of steroids (Prednisone) was started to help Greg.
Greg came in for weekly rechecks to track his improvement. Each week he seemed to be doing better and better. After 2 weeks his ear infections were healed and the skin infection on his nose had improved but was not completely healed. We continued Greg on his oral antibiotics but started slowly decreasing his dose of steroids. Since Greg was doing so great we started pushing his rechecks to every 2 weeks. Greg continued to improve and so his steroids were decreased at each vet visit.
Finally after 5 weeks we were comfortable in Greg’s improvement that he was able to receive his first set of puppy vaccines. We held off vaccinating Greg while treating his puppy strangles for two reasons: 1. a patient with puppy strangles immune system is compromised 2. Greg was on steroids to suppress his immune system therefore this could make the vaccines we give less effective as well as this could compromise his immune system even more.
Greg is doing fantastic at this time and has made a complete recovery. His owners were amazing in staying diligent and were very involved in his treatment plan. It took about 6 weeks to get Greg off of steroids and all other medications and back to his handsome self. He is now a happy healthy puppy!
Greg is now a social media sensation and can be found at Greg_thegolden on Instagram. His progress has been remarkable.