Indian J Sex Transm Dis Indian J Sex Transm Dis
Official Publication of the Indian Association for the Study of Sexually Transmitted Diseases
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  Table of Contents  
PHOTOFEATURE
Year : 2023  |  Volume : 44  |  Issue : 1  |  Page : 87-88
 

Granuloma inguinale diagnosed on the bedside


Department of Dermatology, Armed Forces Medical College, Pune, Maharashtra, India

Date of Submission12-Jul-2022
Date of Decision19-Oct-2022
Date of Acceptance22-Oct-2022
Date of Web Publication09-Dec-2022

Correspondence Address:
Dr. Biju Vasudevan
Department of Dermatology, Armed Forces Medical College, Pune - 411 040, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijstd.ijstd_68_22

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   Abstract 

Donovanosis is a chronic bacterial infection caused by gram-negative bacterium Klebsiella granulomatosis and is characterized by painless beefy red granulomatous ulcer which bleeds on touch and is mostly confined to the endemic regions of the world. It is rarest among the sexually transmitted genital ulcer diseases. We hereby report a case of donovanosis in a non-endemic area who initially presented with a solitary genital ulcer. Initial tests did not reveal any aetiology. However after four days of admission, since no aetiology was coming forth, a repeat tissue smear from the lesion revealed Donovan bodies which helped in the bedside diagnosis and management of the case.


Keywords: Donovan bodies, donovanosis, doxycycline, tissue smear


How to cite this article:
Vendhan D S, Vasudevan B, Gera V, Neema S. Granuloma inguinale diagnosed on the bedside. Indian J Sex Transm Dis 2023;44:87-8

How to cite this URL:
Vendhan D S, Vasudevan B, Gera V, Neema S. Granuloma inguinale diagnosed on the bedside. Indian J Sex Transm Dis [serial online] 2023 [cited 2023 Sep 21];44:87-8. Available from: https://ijstd.org/text.asp?2023/44/1/87/363119


A 22-year-old healthy male with a history of unprotected intercourse 1 month back, presented with solitary well-defined nontender ulcer of size 2 cm × 1.5 cm over the shaft of the penis and corona of glans with red granulation tissue and elevated margins, and purulent discharge on the floor of the ulcer [Figure 1]. There was no inguinal lymphadenopathy. Rest of the venereological examination was normal. A clinical differential of donovanosis and primary syphilis was considered with a premise to rule out other genito-ulcerative diseases. All hematological and biochemical investigations were normal. HIV, venereal disease research laboratory (VDRL), treponema pallidum haemagglutination assay, and anti HSV-1 and 2 antibodies were negative. Gram and Giemsa stains from the lesion on the 1st day of presentation showed multiple neutrophils with Gram-positive cocci in clusters. The patient was managed with normal saline compresses and topical mupirocin awaiting further investigations. Four days later, discharge over the lesion had reduced. Repeat VDRL with prozone phenomenon came out to be negative.
Figure 1: Clinical image of the patient showing ulcer over the corona of glans with red granulation tissue

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Tissue smear with Gram and Giemsa stain was repeated on the 4th day of admission, which showed multiple rod-shaped coccobacilli in the cytoplasm of monocytes characteristic of Donovan bodies and hence confirmed the diagnosis of granuloma inguinale [Figure 2] and [Figure 3]. Patient was unwilling for biopsy of genital lesion. He was administered oral doxycycline twice daily with topical mupirocin ointment for 3 weeks with the complete resolution of the lesions on further follow-up [Figure 4]. He last reported to the OPD after 6 months of the completion of treatment with no relapse or complications.
Figure 2: Gram stain showing multiple rod-shaped coccobacilli in the cytoplasm of monocytes characteristic of Donovan bodies

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Figure 3: Giemsa stain showing multiple rod-shaped coccobacilli in the cytoplasm of monocytes characteristic of Donovan bodies

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Figure 4: Clinical image of patient post treatment with doxycycline showing complete resolution of the ulcer

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The diagnosis of donovanosis can be made by tissue smear and histopathological examination from genital ulcers that demonstrate Donovan's body.[1] Donovan bodies are large intracellular inclusions with deeply staining bodies that have a characteristic safety pin appearance in macrophages.[2] Polymerase chain reaction testing can be done to confirm the diagnosis but is not widely available. Azithromycin 1 g orally once a week or 500 mg daily or doxycycline 100 mg orally twice daily or erythromycin 500 mg orally 4 times a day for more than 3 weeks or until lesions have fully healed, are all effective treatments for donovanosis.[3] This case is reported to bring the message that donovanosis still persists in our country, can be diagnosed at bedside by tissue smear, repeated smears may be required to clinch the diagnosis and early treatment can prevent complications due to the disease.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Ornelas J, Kiuru M, Konia T, Larsen L. Granuloma inguinale in a 51-year-old man. Dermatol Online J 2016;22:13030/qt52k0c4hj.  Back to cited text no. 1
    
2.
Santiago-Wickey JN, Crosby B. Granuloma Inguinale. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2022.  Back to cited text no. 2
    
3.
O'Farrell N, Moi H. 2016 European guideline on donovanosis. Int J STD AIDS 2016;27:605-7.  Back to cited text no. 3
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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