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Ask Dr. Michael Salkin Your Own Question
Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Dog Veterinary
Satisfied Customers: 23770
Experience:  University of California at Davis graduate veterinarian with 44 years of experience
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Our 1 year old Chihuahua has been treated the last 10 days

Customer Question

Our 1 year old Chihuahua has been treated the last 10 days with antibiotics. First it was an injection than antibiotic tablets twice a day. On one of her legs was a small what appeared to be a spider bite.
We saw the that again yesterday as her condition seemed to worsen. He gave her a shot of Enrofloxacin antibiotic injections 1.5 and told us to give her the same injection every 12 hours.
It seems Lily's condition has worsened and sores are breaking out on her muzzle her eyes are worse than yesterday. Does you know of an antitoxin for spider venom? With direction would you go? Should we take her to a local veterinarian hospital. Is it possinle to flush her system with IV? What are your thoughts.
Submitted: 4 months ago.
Category: Dog Veterinary
Customer: replied 4 months ago.
Posted by JustAnswer at customer's request) Hello. I would like to request the following Expert Service(s) from you: Live Phone Call. Let me know if you need more information, or send me the service offer(s) so we can proceed.
Customer: replied 4 months ago.
Where can I send or text Photos. Call me at(###) ###-####
Customer: replied 4 months ago.
Here are Pictures of Lilly's Face
Expert:  Dr. Michael Salkin replied 4 months ago.

You're speaking to Dr. Michael Salkin. Welcome to JustAnswer. I'm currently typing up my reply.

Expert:  Dr. Michael Salkin replied 4 months ago.

I regret that my state board of veterinary examiners doesn't allow me to speak to customers by phone in this venue but other experts in this category may be able to assist you in this regard. Please let me know if you'd like another expert to do so and I'll opt out of this question. Please stay in this conversation if you wish.

To answer you directly, she needs to see another vet with a better understanding of what's going on. When 10 days of an antibiotic isn't helpful, prescribing yet another for what would be a hypersensitivity reaction rather than an infection if a spider bite were actually the etiology of Lilly's malaise, isn't appropriate.

To summarize, I must play devil's advocate and question the diagnosis and therapy. Lilly's face indicates angioedema and urticaria; these are hypersensitivity reactions best addressed with a glucocorticosteroid such as prednisone or dexamethasone rather than antibiotics. If you have a specialty hospital or university veterinary teaching hospital available to you, either would be a good choice for Lily at this time. Please respond with further questions or concerns if you wish.

Customer: replied 4 months ago.
When we first took he to the vet she has a fever, eye infection and swollen lymph nodes. What is your thoughts about her lymph nodes still being swollen? Is this a response to a hypersensitivity reaction? Is the poison toxin being expelled through the lymphatic system? Should we stop administering the antibiotic and look for improvement?
Expert:  Dr. Michael Salkin replied 4 months ago.

My initial thought seeing a young dog with fever, eye involvement and lymphadenopathy (swollen lymph nodes) is juvenile pyoderma ("puppy strangles"). This would also explain the recent muzzle involvement. The etiology of juvenile pyoderma is unclear but it appears to involve a hypersensitivity reaction if only because it responds to glucocorticosteroids such as prednisone. Most of us will also prescribe an antibiotic in the cephalosporin class such as cephalexin because Staphylococcal bacteria are involved; in fact, the hypersensitivity reaction may be due to a reaction against a toxin that is produced by that bacterium. Yes, the lymphatics drain areas of inflammation and so toxins would be found in the lymphatics as well as the blood stream.

Her vet may not be aware that puppy strangles can affect dogs older than puppies. Feel free to share our conversation with her vet. Please continue our conversation if you wish.

Customer: replied 4 months ago.
The glans that are swollen are on the side of her head not the bottom where it would strangle her. Our Vet through a small incision is Lilly's cheek drained off some lymphatic fluid which had blood in it. He said that in 50 years he had never seen this. Both blood and lymph tissue were sent out for analysis. Have you ever heard of blood in the lymph fluid?
Expert:  Dr. Michael Salkin replied 4 months ago.

Lymphedema is a swelling of protein-rich interstitial fluid caused by impaired lymphatic function. Depending upon the cause of the edema, it may be hemorrhagic (bloody) or purulent (pusy). Please let me know the results of the analysis.

Customer: replied 4 months ago.
Lilly is still on antibiotic. Her blood test results were normal. The vet did a biopsy on a lymphatic glan and sent it out, it also came back as normal. He said there was blood in the lymph gleans which came out like a worm and that is his 50 years of practice he never saw anything like it.
Considering the above what are Your thoughts?
Thank You
Customer: replied 4 months ago.
Could this be allergies? This is her first spring and the pollen has been really high.
Customer: replied 4 months ago.
Here are two new photos taken tonight.
Expert:  Dr. Michael Salkin replied 4 months ago.

Not the kind of allergy you're thinking of but, instead, an immune dysfunction which is poorly understood. This still looks like juvenile pyoderma which is also known as sterile granulomatous dermatitis and lymphadenitis or puppy strangles. I believe you'll see a remarkable improvement if Lilly is administered oral prednisone at 1 mg/lb daily until the disease is inactive - usually 14-28 days.

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