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Penis and scrotum
Inflammatory lesions
Granuloma inguinale
Reviewers: Antonio Cubilla, M.D. and Alcides Chaux, M.D. (see Author/Reviewers page)
Revised: 18 February 2010, last major update February 2010
Copyright: (c) 2002-2010, PathologyOutlines.com, Inc.
Definition
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● Sexually transmitted disease caused by Klebsiella granulomatis, formerly Calymmatobacterium granulomatis, a gram negative rod
● Initially a small painful nodule at infection site that ulcerates; may have satellite lesions
Terminology
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● Also called donovanosis
● Initially described in India by McLeod (1882) and Donovan (1905)
Sites
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● Can affect foreskin, glans, penile shaft or scrotum
Epidemiology
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● Rare in US (100 cases/year)
● More common in African-Americans, in individuals with a lower socio-economic status and among those untrained in hygiene
● Endemic in tropical and subtropical climates such as Papua New Guinea, parts of South Africa, parts of India and Indonesia and Australian aborigines (Braz J Infect Dis 2008;12:521)
Etiology
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● Caused by Klebsiella granulomatis, formerly Calymmatobacterium granulomatis, a gram negative rod (Int J Syst Bacteriol 1999;49 Pt 4:1695)
Clinical features
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● Painless, beefy-red ulcer with a characteristic rolled edge of granulation tissue
● Initially small painful nodule at infection site which ulcerates, and may exhibit exuberant granulation tissue
● Lesion spreads by peripheral extension and may have satellite lesions (pseudobuboes)
● Usually no inguinal lymphadenopathy
Case reports
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● 21 year old man with coexisting squamous cell carcinoma (Dermatol Online J 2008;14:8)
● 48 year old man (Dermatology Online Journal 2006;12(7):14)
Treatment
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● Three weeks of treatment with erythromycin, streptomycin or tetracycline or 12 weeks of treatment with ampicillin
● Usually clinical improvement within 1 week
Clinical images
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Ulcerated lesion with hypertrophic borders
AFIP Fig 10-76
Left: nummular ulcerated lesion in mucocutaneous foreskin; base shows red granulation tissue;
another white lesion is present in skin of pubis
Right: massive nodular destruction of penis, scrotum and lower abdominal wall in another case
Beefy red penile ulcer Extensive disease may mimic carcinoma
Micro description (Histopathology)
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● Massive plasma cell infiltrate without lymphocytes in granulation tissue
● Diffuse infiltration by neutrophils forming microabscesses
● Large mononuclear cells (also called Pund cells) with Donovan bodies (large, intracytoplasmic encapsulated bipolar bodies, highlighted with Warthin-Starry or Wright-Giemsa stain)
Micro images
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Donovan bodies
Positive stains
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● Wright-Giemsa or Warthin-Starry stains show Donovan bodies in tissue sample
Electron microscopy descriptions
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● Bacteria residing inside phagosomes of macrophages
Differential Diagnosis
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● Syphilis
Additional references
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End of Penis and scrotum > Infectious disorders > Granuloma inguinale
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