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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: 20 May 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
Granuloma inguinale involving the skin of the scrotum and inner thigh
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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