Puppy Strangles is uncommon, but an alarming disorder that can be seen in puppies from 3 weeks to 4 months of age. It appears initially as acute swelling of the face, primarily of the lips, eyelids, chin, and muzzle. It may easily be confused, early on, with a sudden allergic reaction typical of a bee sting or a vaccine reaction. However, it progresses rapidly into bumps and pustules which drain and scab. The lymph nodes under the neck may enlarge dramatically, which is what precipitated the term "puppy strangles." Half of the cases are lethargic. Up to one quarter of the cases may show fever, appetite loss, and joint pain. The cause of is unknown, although an immune basis is postulated, because of the rapid response to immune-suppressive doses of steroids. Early, aggressive steroid treatment is needed to avoid excessive scar formation. If evidence of concurrent bacterial infection is present, then antibiotics are indicated. The good news is that a relapse is extremely unlikely.