de Bary Barbara E, Heudobler Marlies, Fürst Alois, Utpatel Kirsten, Schuierer Elisabeth, Noor Bengül, Lang Henriette, Audebert Franz, Lampl Benedikt M J
Division of Infection Control and Prevention, Regensburg Department of Public Health, Altmühlstr. 3, 93059, Regensburg, Germany.
Department of General Surgery, Caritas Hospital St. Josef, Landshuter Str. 65, 93053, Regensburg, Germany.
Infection. 2025 Nov 7. doi: 10.1007/s15010-025-02684-9.
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.
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.
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.
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.
结核病仍然是一个重大的全球健康问题，肺外表现占病例的相当比例。然而，肛周结核是结核病的一种罕见表现，由于其非特异性症状以及与其他肛周疾病的相似性，常常导致诊断延迟。
我们报告一例以肛周结核为主要表现并导致同时诊断出肺结核的病例，并基于对Medline的检索进行文献综述。
一名47岁男性出现肛周疼痛和脓性分泌物。手术干预后的组织病理学检查和PCR分析确诊为肛周结核。胸部影像学检查显示肺部有结节状和空洞性病变，提示活动性肺结核。该患者开始接受为期9个月的抗结核治疗。接触者追踪发现两名近亲有潜伏性结核感染。我们的文献检索确定了59篇相关出版物，包括195例病例。大多数患者为男性（88%），中位年龄为42岁，且来自高流行地区。在许多情况下，诊断延迟，从症状出现到确诊的平均时间约为两年（中位时间为6个月）。三分之一的病例同时存在肺结核。
由于肛周结核罕见且临床表现非特异性，其诊断常常延迟。在肛周溃疡性、瘘管性和脓肿形成性病变的鉴别诊断中必须考虑结核病，特别是在病变复发时，以及在来自结核病高流行国家的患者中。在许多情况下，进一步的诊断评估会发现同时存在肺结核，这突出了综合诊断方法的重要性。从临床和公共卫生角度来看，早期诊断和及时开始治疗对于预防疾病进展和传播至关重要。
