Granuloma inguinale
See also in: Cellulitis DDx,AnogenitalAlerts and Notices
Synopsis
After an incubation period of days to months, subcutaneous nodules develop at inoculation sites that later erode. The lesions are usually painless, but in atypical variants of the disease, there may be mild pain. Autoinoculation is a common feature, producing so-called "kissing lesions" on adjacent skin and, less commonly, extending to underlying abdominal organs. Subcutaneous granulomas occur in the inguinal area that mimic lymphadenopathy (so-called pseudo-buboes). Without treatment, chronic lesions can result in lymphatic obstruction leading to genital lymphedema and distortion. Extragenital lesions, including oral, bone, and abdominal organs, are reported in 6% of cases. Constitutional symptoms are notably absent.
In rare cases, squamous cell carcinoma may develop in chronically present ulcers.
Granuloma inguinale predisposes individuals to transmission of human immunodeficiency virus (HIV).
Codes
ICD10CM:A58 – Granuloma inguinale
SNOMEDCT:
28867007 – Granuloma inguinale
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
The differential diagnosis of ulcerating genital lesions, such as those seen in granuloma inguinale, includes the following:- Cellulitis / superinfected traumatic erosions
- Chancroid
- Lymphogranuloma venereum
- Syphilis – Condyloma lata
- Amebiasis
- Tuberculous chancre
- Condyloma acuminata
- Buschke-Lowenstein tumor
- Fournier or gas gangrene
- Herpes simplex virus (HSV)
- Behçet syndrome
- Pyoderma gangrenosum
- Tumors – Squamous cell carcinoma, basal cell carcinoma, melanoma
- Ecthyma gangrenosum
- Crohn disease – May have concurrent genital edema and/or ulceration
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Therapy
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References
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Last Reviewed:05/24/2018
Last Updated:09/22/2021
Last Updated:09/22/2021
Granuloma inguinale
See also in: Cellulitis DDx,Anogenital