Donovanosis — DTM&H MCQ

Correct answer: B — Granuloma inguinale (donovanosis)

Granuloma inguinale (donovanosis), option B, is correct because the pathognomonic finding of intracellular Donovan bodies within macrophages, seen here on punch biopsy of a chronic, well-defined, non-undermined genital or perineal ulcer, is diagnostic of infection with Klebsiella granulomatis. The disease is endemic in Papua New Guinea, southern India, southern Africa, and parts of the Caribbean and South America, fitting the travel/exposure history exactly. Clinically it produces slowly progressive, painless, beefy-red ulcers over months without significant regional lymphadenopathy, matching the 8-month chronicity and well-defined edges described. Diagnosis rests on demonstrating Donovan bodies (safety-pin bipolar-staining bacilli in histiocyte cytoplasm) on Giemsa-stained tissue smear or biopsy, exactly as described in the stem. Why the other options are wrong: E. Cutaneous leishmaniasis: biopsy shows amastigotes (Leishman-Donovan bodies) within macrophages too, but these are protozoal, smaller, lack the bipolar safety-pin bacillary morphology, and lesions are typically on exposed skin from sandfly bites, not genital/perineal ulcers with granulomatous histology described here. A. Chancroid: caused by Haemophilus ducreyi, producing painful ulcers with ragged, undermined edges and painful inguinal lymphadenitis (buboes), which contrasts with the well-defined, non-undermined, painless ulcer in this case; histology shows a mixed inflammatory infiltrate without Donovan bodies. C. Lymphogranuloma venereum: caused by Chlamydia trachomatis serovars L1 to L3; the ulcer is typically small and transient, with the dominant feature being painful inguinal/femoral lymphadenopathy (bubo), not a chronic 8-month ulcer, and biopsy does not show Donovan bodies. D. Primary syphilis: Treponema pallidum causes a painless indurated chancre that resolves spontaneously within weeks; it does not persist for 8 months and biopsy shows spirochaetes on silver stain, not intracellular Donovan bodies. Key point: Intracellular Donovan bodies (bipolar-staining bacilli in macrophage cytoplasm) on tissue smear or biopsy are pathognomonic for granuloma inguinale (donovanosis), distinguishing it from other tropical genital ulcer diseases.

Reference: BASHH, UK national guideline for the management of donovanosis, 2018 (https://www.bashh.org)