Tropical Dermatology — MCQs

Q: Which of the following conditions is characterized by the sign of the groove?

Lymphogranuloma venereum. **Explanation:** **Lymphogranuloma venereum (LGV)** is caused by the **L1, L2, and L3 serovars of *Chlamydia trachomatis***. The "Sign of the Groove" (Greenblatt’s sign) is a pathognomonic clinical finding in the secondary stage of LGV. It occurs when the inguinal and femoral lymph nodes enlarge simultaneously, separated by the rigid **inguinal ligament**. This creates a visible depression or "groove" between the two groups of inflamed lymph nodes. **Analysis of Incorrect Options:** * **B. Granuloma Inguinale (Donovanosis):** Caused by *Klebsiella granulomatis*. It presents with painless, beefy-red, velvety ulcers. It is characterized by "pseudobuboes" (subcutaneous granulation tissue) rather than true lymphadenopathy. * **C. Syphilis:** Primary syphilis presents with a painless, indurated "hard chancre." While it causes bilateral inguinal lymphadenopathy, the nodes are discrete, rubbery, and do not form a groove. * **D. Chancroid:** Caused by *Haemophilus ducreyi*. It presents with painful, soft ulcers and painful inflammatory buboes that are usually unilateral and may suppurate, but they do not form the characteristic groove sign. **High-Yield Clinical Pearls for NEET-PG:** * **Stages of LGV:** Primary (painless papule/ulcer), Secondary (Inguinal syndrome with the Groove sign), and Tertiary (Genito-anorectal syndrome/Elephantiasis). * **Diagnosis:** Frei test (historical), NAAT (current gold standard), and **Donovan bodies** (safety-pin appearance) are seen in Donovanosis, NOT LGV. * **Treatment:** Doxycycline (100 mg BID for 21 days) is the drug of choice for LGV.

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