Trovofloxacin for the treatment of chronic granuloma inguinale.

Recently, the quinolone class of antibiotics has been used successfully in a few patients with granuloma inguinale. We report a case of chronic granuloma inguinale, failing repeated antibiotic treatment over 15 years, which responded to a 2 month course of trovofloxacin. A 33 year old white woman developed granuloma inguinale involving the vulva, left labia, and vaginal canal since about 1982. Over the years, she was treated with doxycycline, ampicillin, erythromycin, trimethoprim/ sulfamethoxazole, intramuscular injection of ceftriaxone, and then intravenous gentamicin or chloramphenicol for several weeks. The patient has had improvement and often short term healing of the ulcers, but has never had resolution of the lesions. She was seen in January 1997 for two recurrent, tender labial ulcers, measuring 1.5 cm × 2 cm each, after failing treatment of 2 months of doxycycline and 3 weeks of ciprofloxacin. Re-biopsy of the ulcer confirmed the diagnosis of chronic granuloma inguinale. Bacterial and viral cultures of ulcer drainage were negative; administration of aciclovir did not result in any improvement. HIV antibody was negative, immunoglobulin level and lymphocytes were unremarkable. Prolonged administration of ofloxacin and azithromycin, followed by intravenous ceftriaxone and oral metronidazole, resulted in initial improvement but ulcers relapsed with increasing necrosis 2 weeks after discontinuation of antibiotics. In October 1998, the patient was given trovofloxacin 200 mg each night. The pain and swelling decreased by day 3 and the ulcer size was reduced by 75% at the end of 1 week of therapy. The patient had mild dizziness while on therapy but completed a total of 2 months of treatment. She has not had recurrence of lesions for over 20 months.