full - fledged cases of donovanosis , characterized by genital ulcerations and buboes are not commonly seen these days . the histological characteristic of the affected tissues closely mimics , and thus , must be differentiated from the rare development of squamous cell carcinoma in the same . an 18-year - old girl presented with complaints of gradually increasing , painless nodule over labia for 8 months . her main concern was a bleeding ulcer at the same site the area of which was increasing progressively over 2 weeks . on examination , there was diffuse enlargement of the right labia [ figure 1 ] which was ulcerated ( 3  3 cm ) . she had characteristic presence of ulcerated bubo ( 2 cm ) formed out of the ipsilateral inguinal lymph node . the clinical diagnosis of donovanosis was made and the patient was referred for histopathological confirmation . a wedge biopsy was taken from the margin of the genital ulcer and impressions smears made from it and the discharging bubo . photograph showing large bleeding ulcer over the right labia with the arrow pointing to the bubo over the right inguinal region microscopic examination revealed fairly cellular smears , which in addition to mature keratinized superficial squamous epithelial cells showed numerous foamy histiocytic cells and macrophages . few small cell clusters with hyperchromatic nuclei , clumped chromatin , and occasional prominent nucleolus were present and a few bizarre cell forms with pyknotic nuclei were also seen . the inflammatory infiltrate comprised of numerous neutrophils , few plasma cells , foamy histiocytes , and vacuolated macrophages with typical basophilic bodies with bipolar condensation of chromatin ( closed safety pin appearance of donovan bodies ) [ figure 2 ] . the epithelium showed pseudoepitheliomatous hyperplasia with long slender finger - like rete - pegs extending down into a heavily inflamed stroma . at places smears from ulcerated site showing bipolar donovan bodies ( h and e , 1000 ) in order to ascertain the nature of pseudoepitheliomatous hyperplasia a deeper biopsy was undertaken from the primary site as well as the pseudobubo a week later . this showed frankly invasive squamous cell carcinoma ( scc ) with numerous islands of mature stratified squamous epithelium and foci of keratin pearl formation . meanwhile , the patient who had been started the standard treatment for donovanosis , did not show even slightest response to therapy . here , we report a disease which has been in obscurity for long but then again came to attention following spread of hiv when it was recognized as one of the causes of its enhanced transmissibility . we have in particular brought to attention a rarer association of this disease with scc that can complicate it . donovanosis ( also known as  granuloma inguinale  or  granuloma venereum ) is caused by calymmatobacterium granulomatosis , a gram - negative non - motile encapsulated bacillus with phylogenetic similarity to the klebsiella species . the disease , although reported from several parts of the world , is known to have certain hot spots of which india is one . accurate epidemiological data is lacking but it is understood that the disease is on the wane . the disease is not always sexually transmitted and there have been suggestions that few cases may occur through fecal contamination and autoinoculation . gradually increasing subcutaneous nodules which erode through the skin to form sharply defined painless ulcers which bleeds readily to touch , is how the disease usually manifests initially . differential diagnoses include chancre , chancroid , herpes , malignancy , and tuberculosis of the cervix . diagnosis rests mainly upon the demonstration of intracellular donovan bodies in mononuclear cells obtained in tissue specimens . pcr and serological methods have been also developed and are being tested for their practical utility . although known , carcinomas are fortunately very rare but a dreaded complication of this disease . in a series by rajam and rangiah in 1954 , carcinoma developed in only 0.25% the patients ; but that was when the disease was much more prevalent and effective treatments were not available . carcinomas are rarely been reported now in the context of donovanosis . in the most recent study published in 2003 , to conclude , donovanosis may be forgotten in general practice , but a forgotten disease keeps reminding itself intermittently . this report is written with an objective of not only just highlighting a very rare complication of donovanosis but also to remind that the disease still exists .
diagnosed cases of sexually transmitted diseases ( std ) represent tip of the iceberg and donovanosis in one of them . 
 donovanosis , in most cases is obvious clinically , but rely for its confirmation on the demonstration of donovan bodies in histological sections and cytological preparation . in an extremely rare setting , 
 this disease may get complicated by the development of squamous cell carcinoma . 
 we report this occurrence in an 18-year - old girl to review the currently forgotten status of donovanosis amongst the stds and the poor outcome of the disease if left untreated .