Perianal ulcerative skin tuberculosis

Abstract

Rationale: Ulcerative skin tuberculosis (TB) is a rare form of extrapulmonary TB. Case report: We present a case of a 65-year-old patient with perianal ulcer, which had been present for 1 year. Anamnesis revealed he had been persistently coughing for the same period of time. Histological examination of perianal skin showed necrotizing granulomatous lesions, acid-fast staining in sputum samples was ++++, TB antibody in the blood was positive, TB DNA test was positive, and chest scan that showed secondary pulmonary TB accompanied by possible pulmonary cavity formation in the 2 upper lungs. Interventions: Anti-TB therapy with isoniazid, rifampicin, ethambutol, and pyrazinamide for 6 months. The skin ulcer completely healed after 6 months. Conclusion: TB should be suspected for nonhealing ulcers. Pertinent studies should be done early during the lesion; finally, TB treatment should be initiated immediately after diagnosis is made.

Primary extensive perianal cutaneous tuberculosis: A challenging diagnosis. Case report and a review of the literature

“…Perianal TB can manifest with local pain, mucopurulent secretion, and multiple complex perianal fistulas, 9 , 10 which we also observed in the case described here. These fistulas can persist and have a prolonged and relapsing course despite proper surgical management.…”

Perianal tuberculosis presenting as a Fournier's gangrene

“…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.…”

“…1 After implantation into the mucosa, the microorganism usually causes an ulcer that is further infected with enteric bacteria. 5 A Fournier's gangrene is a necrotizing fasciitis localized on the external genital organs and perianal region. 6 It can reach 90% mortality rate, if not promptly diagnosed and treated with antibiotic therapy and an emergency surgical debridement.…”