Successful treatment of juvenile sterile granulomatous dermatitis and lymphadenitis in a Pomeranian aged 5 months using topical hydrocortisone aceponate and systemic antibiotic

A 5-month-old intact male Pomeranian puppy was presented with a 2-week history of acutely swollen face, eyelids, lips, and muzzle. A physical examination revealed focal alopecia, folliculitis, and erythema on the muzzle, periocular, and perianal areas; crusts were also found around the muzzle. The puppy received monthly oral afoxolaner and milbemycin oxime. No ectoparasite was observed based on a trichogram test. Skin cytology revealed intracellular cocci and neutrophils. A skin biopsy taken from the muzzle revealed pyogranulomatous perifollicular dermatitis with epidermal spongiosis, intraepidermal pustules, and a superficial crust. This condition was diagnosed as juvenile cellulitis on the basis of age, clinical signs, distribution of the lesions, and the biopsy results. Initially, the puppy was treated with oral amoxicillin/clavulanic acid 25 mg/kg every 12 hours in combination with topical 4% chlorhexidine once daily. After 2 weeks of treatment, the puppy showed marked improvement, with only skin inflammation remaining. Therefore, 0.584 mg/ml hydrocortisone aceponate topical spray was additionally applied once daily for 2 weeks. Systemic antibiotic was continued for 6 weeks until clinically resolved.