RESUMO
A 45-year-old farmer presented with ulcers and plaques over his scrotum for the past 4 to 5 years. The condition started as a small lesion on the shaft of the penis, which improved with treatment; however, after 2 to 3 months, papulonodular lesions developed on the scrotum, which increased in size and subsequently broke down to form ulcers. He denied drug abuse but had a history of multiple unprotected sexual exposures. He was prescribed oral antibiotics, which improved the lesions, but he failed to take the antibiotics for more than a week. He also used powders, lotions, and salves (exact nature not known), which did not help and sometimes even burned the skin. After stopping the medicine, he developed new lesions that followed a similar course. Examination revealed nontender ulcers on the scrotum with raised, rolled-out margins and pale red, granulation tissue that bled on touch (Figure 1). In addition, there were nodules with a pinkish red granular surface and scaly erythematous plaques on the scrotum. Regional lymph nodes were not enlarged.
Assuntos
Antibacterianos/uso terapêutico , Doença de Bowen/patologia , Granuloma Inguinal/patologia , Neoplasias Cutâneas/patologia , Biópsia por Agulha , Doença de Bowen/complicações , Doença de Bowen/diagnóstico , Fármacos Dermatológicos/uso terapêutico , Fazendeiros , Seguimentos , Granuloma Inguinal/complicações , Granuloma Inguinal/diagnóstico , Granuloma Inguinal/tratamento farmacológico , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Recidiva , Medição de Risco , Neoplasias Cutâneas/diagnóstico , Resultado do TratamentoRESUMO
Granuloma inguinale, or Donovanosis, is a rare, sexually transmitted ulcerative disease primarily affecting the genital area. In this report, we present a case of a 50-year-old man that was diagnosed with granuloma inguinale after a 2-month history of a penile ulcer. Histological analysis demonstrated the presence of Donovan bodies within macrophages, confirming the diagnosis. He was subsequently treated with trimethoprim/sulfamethoxazole with improvement in the ulcer. This case serves as a reminder to clinicians that although granuloma inguinale is rarely encountered in the US, it should still be suspected in patients with non-healing penile ulcers.
Assuntos
Granuloma Inguinal/patologia , Doenças do Pênis/patologia , Úlcera/patologia , Antibacterianos/uso terapêutico , Granuloma Inguinal/diagnóstico , Granuloma Inguinal/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Doenças do Pênis/diagnóstico , Doenças do Pênis/tratamento farmacológico , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Úlcera/diagnóstico , Úlcera/tratamento farmacológicoRESUMO
Donovanosis is a chronic genital ulcerative disease caused by the intracellular Gram-negative bacterium Klebsiella granulomatis, reported more frequently in people living with HIV/AIDS (PLHA). Here we present a case of relapsing donovanosis in a PLHA on second line antiretroviral therapy who had episodes of transient unexplained decrease in CD4 counts associated with rapid growth of the lesion and non-responsiveness to treatment followed by clinical resolution coinciding with recovery of the CD4 count.
Assuntos
Síndrome da Imunodeficiência Adquirida , Granuloma Inguinal , Humanos , Granuloma Inguinal/tratamento farmacológico , Síndrome da Imunodeficiência Adquirida/complicações , Seguimentos , Contagem de Linfócito CD4 , Resultado do TratamentoRESUMO
Two infants, 6 months and 4 months of age, presented with bilateral or unilateral external auditory canal polyps and otorrhea, respectively. Additional findings on examination included otitis media and mastoiditis. Tympanic membrane perforation was noted in one patient and a postauricular abscess in the other. Incisional biopsies of the polyps and abscess were reported as nonspecific mixed inflammation and abscess wall, respectively. There was a limited response to an empirical 5-day course of trimethoprim sulfamethoxazole. The children were referred to the academic hospital, and excision of the polyps and biopsies of the middle ear, mastoid, and postauricular abscess was undertaken. All the biopsies demonstrated donovanosis. Reappraisal of the initial incisional biopsies also confirmed donovanosis. Trimethoprim sulfamethoxazole was administered to both patients for 3 weeks, with resolution of the lesions. Subsequent investigations confirmed genital tract donovanosis, human immunodeficiency virus seropositivity, acquired immunodeficiency syndrome, and pulmonary tuberculosis in both mothers. Heightened awareness of the occurrence of donovanosis at unusual sites and improved recognition of the histomorphological features of the disease, especially in small and superficial biopsies, are pivotal not only for its correct diagnosis in extragenital cutaneous and extracutaneous locations but also for timely and adequate therapy and an improved infant and maternal outcome.
Assuntos
Meato Acústico Externo/patologia , Otopatias/patologia , Granuloma Inguinal/patologia , Transmissão Vertical de Doenças Infecciosas , Pólipos/patologia , Anti-Infecciosos/uso terapêutico , Otopatias/tratamento farmacológico , Otopatias/etiologia , Feminino , Granuloma Inguinal/tratamento farmacológico , Granuloma Inguinal/etiologia , Humanos , Lactente , Masculino , Pólipos/tratamento farmacológico , Pólipos/etiologiaAssuntos
Granuloma Inguinal/complicações , Granuloma Inguinal/diagnóstico , Linfadenite/etiologia , Mastoidite/etiologia , Meningite/etiologia , Azitromicina/uso terapêutico , Feminino , Granuloma Inguinal/tratamento farmacológico , Granuloma Inguinal/transmissão , Humanos , Lactente , Transmissão Vertical de Doenças InfecciosasAssuntos
Granuloma Inguinal/diagnóstico , Granuloma Inguinal/tratamento farmacológico , Antibacterianos/uso terapêutico , Azitromicina/uso terapêutico , Chlamydia trachomatis/isolamento & purificação , Ciprofloxacina/uso terapêutico , Eritromicina/uso terapêutico , Granuloma Inguinal/epidemiologia , Humanos , Ofloxacino/uso terapêuticoAssuntos
Anti-Infecciosos/uso terapêutico , Doenças do Ânus/tratamento farmacológico , Doenças do Ânus/microbiologia , Doenças do Ânus/virologia , Cancro/diagnóstico , Cancro/tratamento farmacológico , Infecções por Chlamydia/diagnóstico , Infecções por Chlamydia/tratamento farmacológico , Giardíase/diagnóstico , Giardíase/tratamento farmacológico , Gonorreia/diagnóstico , Gonorreia/tratamento farmacológico , Granuloma Inguinal/diagnóstico , Granuloma Inguinal/tratamento farmacológico , Herpes Genital/diagnóstico , Herpes Genital/tratamento farmacológico , Humanos , Sífilis Cutânea/diagnóstico , Sífilis Cutânea/tratamento farmacológicoRESUMO
Donovanosis is a chronic, progressive, and indolent bacterial disease that affects the skin and mucous membranes of the genital and perigenital regions, often associated with sexual transmission, and with low infectivity. The malignant transformation of donovanosis lesions occurs exceptionally, as is usually seen in long-term ulcerations.
Assuntos
Granuloma Inguinal , Granuloma Inguinal/diagnóstico , Granuloma Inguinal/tratamento farmacológico , Humanos , Pele , ÚlceraRESUMO
A 29-year-old female presented with chronic postpartum abdominal pain. Computerized tomography scan was consistent with ovarian carcinoma, and biopsy yielded macrophages laden with eosinophilic bodies. Cultures, histoplasma serologies, and taxoplasma serologies were negative. A diagnosis of pelvic donovanosis was reached; the patient was treated with azithromycin resulting in clinical and radiographic resolution.
Assuntos
Granuloma Inguinal/diagnóstico , Doenças Ovarianas/diagnóstico , Doenças Ovarianas/microbiologia , Neoplasias Ovarianas/diagnóstico , Dor Abdominal/microbiologia , Adulto , Antibacterianos/uso terapêutico , Azitromicina/uso terapêutico , Diagnóstico Diferencial , Feminino , Granuloma Inguinal/diagnóstico por imagem , Granuloma Inguinal/tratamento farmacológico , Humanos , Doenças Ovarianas/diagnóstico por imagem , Doenças Ovarianas/tratamento farmacológico , Neoplasias Ovarianas/diagnóstico por imagem , Infecção Puerperal/diagnóstico , Infecção Puerperal/diagnóstico por imagem , Infecção Puerperal/tratamento farmacológico , Infecção Puerperal/microbiologia , Tomografia Computadorizada por Raios XRESUMO
Sexually transmitted diseases (STDs) continue to be underrecognized leading to devastating health and economic consequences. Emergency clinicians play an important role in diagnosing and managing STDs and in improving health care outcomes for both the patient and their partners. In addition, antibiotic resistance and emerging infections continue to challenge providers in clinical practice. This review focuses on the cause, history, physical examination, diagnostic studies, and treatment strategies for bacterial vaginosis, chlamydia, genital herpes, gonorrhea, human papillomavirus, granuloma inguinale, Lymphogranuloma Venereum, Mycoplasma genitalium, syphilis, and trichomoniasis.
Assuntos
Serviço Hospitalar de Emergência , Infecções Sexualmente Transmissíveis/diagnóstico , Anti-Infecciosos/uso terapêutico , Infecções por Chlamydia/diagnóstico , Infecções por Chlamydia/tratamento farmacológico , Feminino , Gonorreia/diagnóstico , Gonorreia/terapia , Granuloma Inguinal/diagnóstico , Granuloma Inguinal/tratamento farmacológico , Herpes Genital/diagnóstico , Herpes Genital/tratamento farmacológico , Humanos , Masculino , Parceiros Sexuais , Infecções Sexualmente Transmissíveis/tratamento farmacológico , Sífilis/diagnóstico , Sífilis/tratamento farmacológico , Vaginite por Trichomonas/diagnóstico , Vaginite por Trichomonas/tratamento farmacológico , Vaginose Bacteriana/diagnóstico , Vaginose Bacteriana/tratamento farmacológicoRESUMO
Donovanosis is endemic in various parts of the world. Although donovanosis has been reported to co-exist with the human immunodeficiency virus (HIV) infection, to our knowledge there have been no reports of co-existent squamous cell carcinoma (SCC) in an HIV positive patient. In our case the patient did not respond to treatment for donovanosis and on biopsy we realized that the patient had coexistent SCC, which is hitherto unreported with granuloma inguinale.
Assuntos
Carcinoma de Células Escamosas/complicações , Granuloma Inguinal/complicações , Infecções por HIV/complicações , Neoplasias Penianas/complicações , Neoplasias Cutâneas/complicações , Amputação Cirúrgica , Antibacterianos/uso terapêutico , Fármacos Anti-HIV/uso terapêutico , Terapia Antirretroviral de Alta Atividade , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/terapia , Transformação Celular Neoplásica , Quimioterapia Adjuvante , Terapia Combinada , Progressão da Doença , Doxiciclina/uso terapêutico , Granuloma Inguinal/tratamento farmacológico , Granuloma Inguinal/patologia , Infecções por HIV/diagnóstico , Infecções por HIV/tratamento farmacológico , Humanos , Masculino , Neoplasias Penianas/patologia , Neoplasias Penianas/terapia , Radioterapia Adjuvante , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/terapia , Úlcera Cutânea/etiologia , Adulto JovemRESUMO
The objective of this guideline is to provide guidance for the diagnosis and management of donovanosis, a now rare sexually transmitted infection. This guidance is primarily for professionals working in UK Sexual Health services (although others may find it useful) and refers to the management of individuals presenting with possible symptoms of donovanosis who are over the age of 16. An updated literature review since the last Clinical Effectiveness Group (CEG) guideline produced for this condition in 2011 has shown few new developments. Most reports in the literature relate to cases of unusual presentations of the condition.
Assuntos
Antibacterianos/uso terapêutico , Granuloma Inguinal/diagnóstico , Granuloma Inguinal/tratamento farmacológico , Guias de Prática Clínica como Assunto , Adulto , HumanosRESUMO
Donovanosis is a chronic infectious disease caused by the Gram-negative bacteria Klebsiella granulomatis, which mainly affects the skin and mucous membranes of the genital, perigenital, and inguinal regions. Also known as venereal granuloma or granuloma inguinale, it is endemic in tropical and subtropical regions of the globe and often associated with sexual transmission. We report the case of an 11-year-old female victim of chronic sexual abuse, who was diagnosed with donovanosis and presented a good therapeutic response to doxycycline.
Assuntos
Maus-Tratos Infantis , Granuloma Inguinal/diagnóstico , Delitos Sexuais , Antibacterianos/uso terapêutico , Criança , Doxiciclina/uso terapêutico , Feminino , Granuloma Inguinal/tratamento farmacológico , Granuloma Inguinal/etiologia , HumanosRESUMO
We report on a patient from a London clinic, (a Jamaican heterosexual man known to have herpes) who has donovanosis and syphilis in a single genital ulcer. The case highlights the importance of careful clinical examination of genital ulcers.
Assuntos
Granuloma Inguinal/diagnóstico , Herpes Simples/diagnóstico , Doenças do Pênis/microbiologia , Sífilis/diagnóstico , Azitromicina/uso terapêutico , Doxiciclina/uso terapêutico , Granuloma Inguinal/tratamento farmacológico , Herpes Simples/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Doenças do Pênis/tratamento farmacológico , Sífilis/tratamento farmacológicoRESUMO
Ten patients with donovanosis were treated with thiamphenicol for two weeks. In eight of them, included two HIV infected patients, lesions healed. The safety profile of thiamphenicol makes it a useful and cost-effective agent in the management of donovanosis. Randomized controlled trials should be conducted with these treatment options.
Assuntos
Antibacterianos/uso terapêutico , Granuloma Inguinal/tratamento farmacológico , Doenças do Pênis/tratamento farmacológico , Tianfenicol/uso terapêutico , Seguimentos , Humanos , Masculino , Doenças do Pênis/microbiologia , Resultado do TratamentoRESUMO
Donovanosis is a rare, chronic and indolent sexually transmitted infection caused by Klebsiella granulomatis. The ulcers in donovanosis rarely undergo malignant transformation, which is usually seen in longstanding ulcers. We present a case of a 32-year-old male who presented with a two-month history of rapidly progressive, large, foul-smelling ulcers over the groin, distal penile shaft and scrotum. Crushed tissue smears from ulcers revealed basophilic intracellular and extracellular Donovan bodies. Fine needle aspiration cytology from inguinal lymph nodes and biopsy from the ulcers revealed well-differentiated squamous cell carcinoma. The current case aims to alert clinicians that donovanosis is a rare but possible cause of cutaneous malignancy. Nonetheless, the pathogenesis of malignant transformation in donovanosis needs further research.
Assuntos
Carcinoma de Células Escamosas/diagnóstico por imagem , Doxiciclina/administração & dosagem , Granuloma Inguinal/diagnóstico por imagem , Granuloma Inguinal/diagnóstico , Úlcera/diagnóstico por imagem , Adulto , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Biópsia , Carcinoma de Células Escamosas/tratamento farmacológico , Carcinoma de Células Escamosas/patologia , Granuloma Inguinal/tratamento farmacológico , Granuloma Inguinal/patologia , Humanos , Masculino , Pênis/patologia , Úlcera/tratamento farmacológico , Úlcera/patologiaRESUMO
Granuloma inguinale is common in certain regions of the world, however, it is rarely reported in the United States. It is the result of infection by Calymmatobacterium granulomati, although current literature proposes to re-classify this organism as Klebsiella granulomati. Here we report a case of granuloma inguinale, review the literature, and discuss historical context, treatment options, and differential diagnosis.
Assuntos
Granuloma Inguinal/diagnóstico , Granuloma Inguinal/tratamento farmacológico , Antibacterianos/uso terapêutico , Doxiciclina/uso terapêutico , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Donovanosis is a rare sexually transmitted infection now mainly seen in sporadic cases in Papua New Guinea, South Africa, India, Brazil and Australia. The causative organism is Calymmatobacterium granulomatis, though a proposal has been put forward that the organism be reclassified as Klebsiella granulomatis comb nov The incubation period is approximately 50 days with genital papules developing into ulcers that increase in size. Four types of lesions are described - ulcerogranulomatous, hypertrophic, necrotic and sclerotic. The diagnosis is usually confirmed by microscopic identification of characteristic Donovan bodies on stained tissue smears. More recently, polymerase chain reaction methods have been developed. The recommended treatment is azithromycin 1 g weekly until complete healing is achieved.
Assuntos
Antibacterianos/urina , Calymmatobacterium , Granuloma Inguinal/diagnóstico , Granuloma Inguinal/tratamento farmacológico , Guias de Prática Clínica como Assunto , Busca de Comunicante , Humanos , Reação em Cadeia da Polimerase , Parceiros Sexuais , Infecções Sexualmente TransmissíveisRESUMO
The authors present a case of disseminated granuloma inguinale with bilateral psoas abscesses. Infection with calymmatobacterium granulomatis is usually localized to the genital organs but rarely may be disseminated. A search of the literature revealed that only two cases of psoas abscesses due to calymmatobacterium granulomatis were previously reported
Assuntos
Granuloma Inguinal/complicações , Granuloma Inguinal/diagnóstico , Abscesso do Psoas/complicações , Abscesso do Psoas/diagnóstico , Adulto , Antibacterianos/uso terapêutico , Biópsia por Agulha , Países em Desenvolvimento , Feminino , Seguimentos , Granuloma Inguinal/tratamento farmacológico , Humanos , Imuno-Histoquímica , Abscesso do Psoas/tratamento farmacológico , Doenças Raras , Medição de Risco , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Índias OcidentaisRESUMO
Abstract Donovanosis is a chronic, progressive, and indolent bacterial disease that affects the skin and mucous membranes of the genital and perigenital regions, often associated with sexual transmission, and with low infectivity. The malignant transformation of donovanosis lesions occurs exceptionally, as is usually seen in long-term ulcerations.