Paediatric Team Diagnoses Rare Case of Infant Donovanosis

Professor Raziya Bobat.

The Head of UKZN’s Department of Paediatrics Infectious Diseases, Professor Raziya Bobat, recently published a case report in The Lancet.

It was co-authored with four of her colleagues:  Dr Nadia Ahmed, an ID specialist from London; Dr Ashendrie Pillay; Dr  Melissa Lawler and Dr Moherndran Archary.

The case report concerned an eight-month-old girl who presented at King Edward VIII Hospital in Durban last year with a three-month history of left ear pain, fever, and progressive neck swelling.

The child had a large left-sided parotid abscess and a left lower motor neuron facial nerve palsy.

‘Our initial diagnosis was bacterial parotid abscess so we started intravenous antibiotics. The child underwent an incision and drainage and biopsy samples of the abscess wall were sent for bacterial, mycobacterial, and fungal culture,’ said Bobat.

‘The left cervical and intra-parotid lymph nodes showed caseation. A CT scan of the brain showed extensive erosion of the left mastoid with bilateral lymphadenitis and a collection in the left parapharyngeal space, suggestive of lymphadenopathy, with necrosis and suppuration due to tuberculosis. A Lumbar puncture confirmed meningitis and the child was given an intravenous ceftriaxone, anti-tuberculosis treatment, and intravenous steroids.

‘Histology samples taken at surgery showed sheets of histiocytes with collections of micro-abscesses within which large numbers of Donovan bodies were highlighted on Giemsa and Warthin starry stains. The features were in keeping with granuloma inguinale of the parotid region,’ said Bobat.

‘We made a diagnosis of Donovanosis of the middle ear with secondary parotid, cervical, and parapharyngeal lymphadenitis, mastoiditis, and meningitis, and changed the antibiotics to clarithromycin and amikacin. The neck lesion healed and the facial palsy resolved two weeks after changing antibiotics.’

Donovanosis in children is extremely rare. It is regarded as an STD and transmission to a child may occur through contact with the mother’s untreated ulcers.