Department of Colorectal Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang, China.
J Pak Med Assoc. 2022 May;72(5):978-980. doi: 10.47391/JPMA.4019.
Perianal tuberculosis (TB) is an extremely rare form of mycobacterial infection, in which the anal mucocutaneous junction becomes infected by autoinoculation from an active draining gastrointestinal tract infection. The case of a 73-year-old immunocompetent male patient, who came in with a refractory perianal ulcer is presented. The patient had no history of TB and his lab tests for TB were all negative. A chest X-ray showed streak and nodular opacities in both upper lungs. The ulcer was biopsied twice and a diagnosis of TB was finally rendered by histological examination with confirmatory Polymerase chain reaction (PCR). The lesion was finally cured by intensive anti-TB treatment. Perianal TB needs to be excluded in patients with a refractory perianal ulcer, including immunocompetent cases without TB history. Biopsies and microbiological tests should be performed for any suspicious lesion and repeated if there is high clinical concern. Consideration of differential diagnoses, especially inflammatory bowel disease, is essential. Early and sufficient antitubercular treatment should be initiated to minimize morbidity.
肛周结核（TB）是一种极其罕见的分枝杆菌感染形式，其中肛门黏膜交界处通过来自活动性胃肠道感染的自身接种而感染。本文介绍了一位 73 岁免疫功能正常的男性患者，他因难治性肛周溃疡就诊。该患者无 TB 病史，其 TB 实验室检查均为阴性。胸部 X 线显示双肺上部有条纹和结节状混浊。溃疡进行了两次活检，最终通过组织学检查和聚合酶链反应（PCR）确诊为 TB。病变最终通过强化抗 TB 治疗治愈。对于难治性肛周溃疡患者，包括无 TB 病史的免疫功能正常患者，均应排除肛周 TB。对于任何可疑病变，都应进行活检和微生物学检查，如果临床高度怀疑，应重复进行。考虑鉴别诊断很重要，特别是炎症性肠病。应尽早开始充分的抗结核治疗，以最大程度地减少发病率。
