Abstract
Background: Extra pulmonary tuberculosis (TB), with or without pulmonary lesions, can be found in any organ, including cutaneous involvement, which is a relatively uncommon manifestation and can be acquired either exogenously or endogenously. Among them, rare individuals develop tuberculosis cutis orificialis (TCO) of the mucosa and orificial skin (nose, mouth and anus). Those patients usually suffer from both advanced TB of the gastrointestinal tract, lungs, or genitourinary tract and dramatically impaired cell-mediated immunity. Perianal TB is an extremely rare form which anal mucocutaneous junction becomes infected when mycobacteria are introduced by autoinoculation from gastrointestinal tract draining active TB infection. Due to its rarity, perianal TB could be misclassified as other diseases (e.g. inflammatory bowel disease) and leads to delayed managements in the clinical practise. Case presentation: We report a 73-year-old male patient presented with a refractory perianal ulcer. The diagnosis of TB is rendered by histological examination and confirmed by Polymerase chain reaction (PCR). The lesion was responsive to initial short-course treatment of 2HRZE/4HR antitubercular regimen, but shortly relapsed. The patient was finally cured by supplemental intensive treatment of 3HRZE/6HR regimen. Conclusions: Perianal TB is extremely rare but need to be excluded in immunosuppressed patients with refractory perianal ulcer that do not respond to antibacterial treatment. Microbiological tests should be performed for any suspicious persistent nonhealing wound or ulcer. Differential diagnoses, especially inflammatory bowel disease, are important. Early and sufficient antitubercular treatment should be initiated to minimize morbidity.
A short course of corticosteroids prior to surveillance colonoscopy to decrease mucosal inflammation in inflammatory bowel disease patients: Results from a randomized controlled trial