Chronic gluteal donovanosis due to Klebsiella granulomatis: First autochthonous case in Morocco

Donovanosis is a sexually transmitted infection caused by Klebsiella granulomatis , typically described in endemic areas as a genital ulcerative disease. Extragenital and atypical presentations are rare and may lead to significant diagnostic delay. We report the first autochthonous case in Morocco, involving a 42-year-old man with a chronic atypical gluteal lesion evolving for more than two years and multiple non-diagnostic investigations. Direct microscopic examination of deep lesion samples using May–Grünwald–Giemsa and Gram staining, including crush smear technique, revealed numerous intracellular bacilli within macrophages, morphologically consistent with Donovan bodies, strongly supporting the diagnosis of donovanosis. Cultures remained negative for K. granulomatis while Enterococcus sp. was isolated as a secondary infection. The patient showed significant clinical improvement after 21 days of doxycycline therapy combined with partial surgical excision, with progressive re-epithelialization and no recurrence at last follow-up. Initial histopathological findings were non-specific but subsequent analysis of the surgical specimen supported the microbiological diagnosis. This case highlights the diagnostic challenges of atypical extragenital donovanosis and emphasizes the key role of direct microscopy in resource-limited settings. • Atypical chronic gluteal donovanosis in a Moroccan patient with no travel history • Diagnosis confirmed by identification of intracellular Donovan bodies on direct microscopy • Klebsiella granulomatis cultures remained negative, consistent with its growth characteristics • Doxycycline treatment led to clinical improvement; partial surgical excision aided functional recovery • Direct cytological examination is crucial for diagnosis in non-endemic settings