Patient with disseminated tuberculosis and rare perianal involvement

Uribe-Bojanini, Esteban; Santa-Vélez, Catalina; Ruiz-Suárez, Ana Cristina; Buchely-Ibarra, N.

doi:10.1016/j.ad.2016.05.018

Cited by 3 publications

(4 citation statements)

References 9 publications

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“…Five cases TB were treated empirically without initial microbiological evidence (3,5,9,14,15). Our review (4,(16)(17)(18)(19)(20)(21) found that the majority of cases (35%) diagnosed disseminated tuberculosis from a biopsy (7/20). Indonesia's National Tuberculosis Control Program, which was adopted from the WHO tuberculosis treatment guidelines, recommends that subject with a negative AFB but with clinical symptoms and a chest X-ray that is suggestive of TB, should be treated for tuberculosis smear-negative with further mycobacteria culture confirmation.…”

Section: Discussionmentioning

confidence: 90%

Massive Disseminated Tuberculosis in an Immunocompetent Patient: Early Diagnostic and Empiric Treatment Approach from an Endemic Country: Indonesia (A Case Report and Literature Review)

Widysanto¹,

Soetjipto²,

Lugito³

2019

Respir Case Rep

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Tuberculosis is still rampant, despite the centuries of efforts to conquer it. Indonesia is host to the third highest TB burden in the world, with an uneven distribution of health care access, and especially to highly sensitive and specific molecular investigations. Rapid and accurate TB diagnosis is crucial for the control of the infection. An AFB smear test is easily accessed and is cost-effective, although there are a number of shortcomings with the approach. We report here on a case of negative acid-fast bacilli (AFB) smear disseminated tuberculosis (TB) in a previously healthy 23year-old Indonesian female who presented to a secondary care facility with pulmonary, pericardial, peritoneal, utero-ovarian, genitourinary and splenic involvement. The clinician chose to start antituberculosis therapy without a positive microbiology and biopsy for bacterial load containment purposes, considering also the patient's clinical and endemic epidemiology. The diagnosis was confirmed with a positive mycobacterial culture after the initiation of anti-tuberculosis therapy. In the present study, we also review the diagnosis of 20 other cases of disseminated tuberculosis reported in other countries.

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Section: Discussionmentioning

confidence: 90%

Massive Disseminated Tuberculosis in an Immunocompetent Patient: Early Diagnostic and Empiric Treatment Approach from an Endemic Country: Indonesia (A Case Report and Literature Review)

Widysanto¹,

Soetjipto²,

Lugito³

2019

Respir Case Rep

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“…Findings consistent with extensive necrotizing fasciitis, specifically Fournier's gangrene. 4.5 × 10 9 /L, C-reactive protein (CRP) level of 59.7 mg/dL, procalcitonin (PCT) level of 9.9 μg/L, serum creatinine level of 2.89 mg/dL, and urea level of 128 mg/dL. An abdominal CT scan (Figure 1) showed a 6.3 × 2.6 × 4.9 cm 3 left perianal abscess with gas accumulation in the space of Retzius, base of the penis, intergluteal region, and ischiorectal fossa.…”

Section: Case Historymentioning

confidence: 99%

“…1 Tuberculosis cutis orificialis, involving anal and perianal areas, 1,3 is an extremely rare type of extrapulmonary tuberculosis comprising less than 1% of digestive tract incidence 2 and in less than 0.0015% of all cases of tuberculosis. 4 It is believed that its prevalence might be underestimated due to misdiagnosis as Crohn's or other granulomatous diseases. 2 According to Tago et al there were 58 cases of perianal tuberculosis described in the literature between 1970 and 2014.…”

Section: Introductionmentioning

confidence: 99%

“…2 According to Tago et al there were 58 cases of perianal tuberculosis described in the literature between 1970 and 2014. 2 Tuberculosis cutis orificialis is caused by autoinoculation of the bacillus into the anal or perianal skin and mucous membranes in patients with active gastrointestinal tuberculosis, 1,3 hematogenous spread of a preexisting tuberculosis infection in another organ (e.g., pulmonary focus) or tissue, 4,5 ingestion of sputum containing active pulmonary disease bacilli 1,4 or lymphatic dissemination of intestinal or genitourinary disease from regional lymph nodes. 1 After implantation into the mucosa, the microorganism usually causes an ulcer that is further infected with enteric bacteria.…”

Section: Introductionmentioning

confidence: 99%

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Perianal tuberculosis presenting as a Fournier's gangrene

Lalanda,

Barão,

Draiblate

et al. 2024

Clinical Case Reports

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Key Clinical MessageIn the setting of Fournier's gangrene, atypical clinical manifestations and complications in an immunocompetent patient warrant consideration of perineal tuberculosis as a potential underlying cause.AbstractTuberculosis cutis orificialis is a rare form of extrapulmonary tuberculosis that affects the perianal region. Fournier's gangrene is an aggressive necrotizing fasciitis that primarily involves the perianal area and external genitalia. A previously healthy 38‐year‐old man presented with a left perianal abscess. His condition deteriorated, leading to septic shock and multiorgan dysfunction syndrome. A CT scan displayed extensive necrotizing fasciitis. Treatment included broad‐spectrum antibiotics, numerous surgical perineal debridements, a transverse loop colostomy, and hyperbaric oxygen therapy. We believe the patient had pre‐existing asymptomatic, non‐diagnosed perianal tuberculosis, and a subsequent bacterial superinfection resulted in a perineal local abscess that progressed to severe Fournier's gangrene. The diagnosis of tuberculosis was confirmed through positive cultures and molecular identification in perineal biopsies. The patient experienced a complex clinical course with complications such as myocardial necrosis, acute respiratory distress syndrome, rhabdomyolysis with severe critical illness polyneuromyopathy and internal jugular thrombosis. Fournier's gangrene resulted in air dissection throughout the perineal fasciae, extending to the abdominal wall muscles resulting in an infected extraperitoneal spontaneous hematoma, probably caused by therapeutic anticoagulation. An extraperitoneal surgical drainage was performed. This case emphasizes the complexities in diagnosing and managing both perianal tuberculosis and Fournier's gangrene.

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Isolated ano-perianal tuberculosis: challenging diagnosis

Boudabous¹,

Amouri²,

Mnif³

et al. 2019

GHOA

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The tuberculosis is a public health issue. The ano-perianal localization is very rare, representing less than 0.7% of the digestive localizations. Basing on personal observation and literature review, we cite the diagnostic difficulties and the epidemic clinical, therapeutic and evolutive particularities of this rare entity. A 34year-old-women was admitted for the exploration of chronic suppuration of the perianal and gluteal region which has been in progress since 10years. Many investigations were made and we retained the diagnosis of ano-perianal tuberculosis localization after detecting the presence of Koch bacillus on Lowenstein Jensen culture of biopsies and stools. The patient was treated with Quadratherapy. Our observation illustrates the difficulties in diagnosing ano-perineal tuberculosis with chronic anal suppuration causing a delayed diagnosis and therapeutic management.

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Patient with disseminated tuberculosis and rare perianal involvement

Cited by 3 publications

References 9 publications

Massive Disseminated Tuberculosis in an Immunocompetent Patient: Early Diagnostic and Empiric Treatment Approach from an Endemic Country: Indonesia (A Case Report and Literature Review)

Massive Disseminated Tuberculosis in an Immunocompetent Patient: Early Diagnostic and Empiric Treatment Approach from an Endemic Country: Indonesia (A Case Report and Literature Review)

Perianal tuberculosis presenting as a Fournier's gangrene

Isolated ano-perianal tuberculosis: challenging diagnosis

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