Perianal tuberculosis with active pulmonary tuberculosis - a case report and review of the literature.

INTRODUCTION: Tuberculosis (TB) remains a significant global health issue, with extrapulmonary manifestations accounting for a notable proportion of cases. Perianal tuberculosis, however, is a rare presentation of TB, often leading to delayed diagnosis due to its nonspecific symptoms and similarity to other perianal diseases.

METHODS: We present a case of perianal TB as primary manifestation leading to the diagnosis of simultaneous pulmonary TB, and a review of the literature based on a search in Medline.

RESULTS: A 47-year-old male presented with perianal pain and purulent discharge. Histopathological examination and PCR analysis following surgical intervention confirmed the diagnosis of perianal TB. Chest imaging revealed nodular and cavitary lung lesions, indicating active pulmonary TB. The patient was initiated on a 9-month anti-tuberculosis treatment. Contact tracing identified latent TB infections among two close family members. Our literature search identified 59 relevant publications comprising 195 cases. The majority of the patients were male (88%), with a median age of 42 years, and originated from high prevalence regions. In many instances, diagnosis was delayed, with a mean duration of approximately two years from symptom onset to confirmation (median 6 month). Pulmonary tuberculosis was concurrently present in one third of the cases.

CONCLUSION: Diagnosis of perianal TB is often delayed due to its rarity and nonspecific clinical presentation. TB must be considered in the differential diagnosis of ulcerative, fistulous and abscess-forming lesions of the perianal area, especially if recurrent, and in patients originating from high prevalence countries of TB. In many cases, further diagnostic evaluations reveal simultaneous pulmonary tuberculosis, underscoring the importance of a comprehensive diagnostic approach. From a clinical and public health perspective, early diagnosis and prompt initiation of treatment are essential to prevent disease progression and transmission.