Nodal Donovanosis as the Sentinel Clue to Acquired Immunodeficiency Syndrome

Objective: Donovanosis, caused by Calymmatobacterium granulomatis, is a recognized cause of genital ulcer disease. Extragenital donovanosis in acquired immunodeficiency syndrome (AIDS) and lymph nodes is documented rarely. The aim of this report is to highlight implications of lymph node involvement as the initial manifestation of donovanosis, especially in AIDS. Materials and methods: This is a retrospective clinicopathological 6 year study that reviewed the features of lymph node biopsies and patients presenting with nodal donovanosis. Results: Of a total of 198 patients with donovanosis, 4 patients with nodal disease were identified. Patient 1, on anti-tuberculous therapy for pulmonary tuberculosis for 2 weeks, developed subcutaneous nodules on her legs and left-sided inguinal lymphadenopathy. Biopsies confirmed erythema induratum and nodal donovanosis in the former and latter sites, respectively. Patients 2 and 3 presented with right-sided inguinal lymphadenopathy that simulated lymphoma. Lymph node biopsy confirmed donovanosis. Further examination on follow-up, confirmed ulcers on the cervix and penis, in patients 2 and 3, respectively. Biopsies of these genital ulcers demonstrated donovanosis in both patients. Patient 4 presented with a left-sided neck mass, biopsy of which confirmed nodal donovanosis. Subsequent biopsy of a pre-auricular ulcer and of the cervix confirmed donovanosis. HIV seropositivity and AIDS were confirmed in all patients. Patient 1 died of pulmonary tuberculosis while disease resolution was achieved in the others following 4-6 weeks of trimethoprim-sulfamethoxazole treatment. Conclusion: Heightened clinicopathological recognition of nodal donovanosis, lymph node biopsy and careful histomorphological assessment thereof are pivotal, not only for diagnostic confirmation of nodal donovanosis and its distinction from other common nodal infections, especially in the AIDS context, but also as a sentinel clue to genital donovanosis, HIV infection and AIDS.