Tubercular etiology in a pilonidal sinus of the forehead: Truth or myth?

Abstract

Pilonidal sinuses are a well-described surgical condition first recognised in the 19th century. They have most commonly been reported in the intergluteal cleft; involvement of other sites is limited to isolated case reports. Association of this condition with tuberculosis is rare and how the two conditions affect each other's causation is poorly understood. We report a rare case showing tubercular pathology in a chronic pilonidal sinus on the forehead of a young lady. A careful review of the lesion was required before labelling it as non-tubercular. The histopathological similarity between a foreign body reaction and tuberculosis in such lesions may confuse the clinician, and therefore differentiation is important to prevent morbidity associated with anti-tubercular therapy.

Unusual sites and presentations of pilonidal sinus disease

“…It is dif fi cult to ex plain the pos si ble cause of tu ber cu lar af fec tion in the pilonidal si nuses. Cu ta ne ous tu ber cu lar ab scess can oc cur from ex ten sion of an em bo lism to subcu ta ne ous tis sue (such as pul mo nary foci or di rect skin in oc u la tion) or from ex ten sion of an un der ly ing lymphadenitis, synovitis, or osteomyelitis 14 . TB has also been described fol low ing sub cu ta ne ous or in tra mus cu lar in jection.…”