Diagnostic and therapeutic challenges in isolated perianal tuberculosis: A case report and comprehensive management overview

Anis Belhaj; Ahmed Omry; Med Dheker Touati; Med Raouf Ben Othmane; Ahmed Saidani; Faouzi Chebbi

doi:10.1016/j.ijscr.2024.109770

Diagnostic and therapeutic challenges in isolated perianal tuberculosis: A case report and comprehensive management overview

Int J Surg Case Rep. 2024 Jun:119:109770. doi: 10.1016/j.ijscr.2024.109770. Epub 2024 May 17.

Authors

Anis Belhaj¹, Ahmed Omry², Med Dheker Touati¹, Med Raouf Ben Othmane¹, Ahmed Saidani¹, Faouzi Chebbi¹

Affiliations

¹ General Surgery Department, Mahmoud El Matri Hospital, Ariana, Tunisia; Faculty of Medicine of Tunis, 15, Djebel Lakhdhar Street - 1007 Bab Saadoun, Tunis, Tunisia.
² General Surgery Department, Mahmoud El Matri Hospital, Ariana, Tunisia; Faculty of Medicine of Tunis, 15, Djebel Lakhdhar Street - 1007 Bab Saadoun, Tunis, Tunisia. Electronic address: omriahmed95@gmail.com.

Abstract

Introduction and importance: Tuberculosis (TB) remains a significant global health concern, particularly in low-income countries like Tunisia, despite advancements in healthcare and antibiotic accessibility. Gastrointestinal tuberculosis, although rare, can affect various parts of the gastrointestinal tract, with perianal involvement being exceptionally uncommon. We present a case of isolated perianal tuberculosis, emphasizing the complexities in diagnosis and management. In this context, we present a case of isolated perianal tuberculosis in a 51-year-old male, highlighting the diagnostic challenges and emphasizing the need for early recognition and comprehensive management strategies.

Case presentation: A 51-year-old male presented with recurrent anal pain and purulent perianal discharge, without respiratory or gastrointestinal symptoms. Physical examination revealed indurated ulceration and fistulas, suggestive of recurrent anal fistulas. Biopsy and culture confirmed the diagnosis of isolated perianal tuberculosis, with no pulmonary or gastrointestinal involvement.

Clinical discussion: Perianal tuberculosis presents unique challenges in diagnosis and management, often mimicking other conditions like Crohn's disease. Differential diagnosis requires a multidisciplinary approach, including biopsy, acid-fast staining, polymerase chain reaction, and cultures. Successful management involves a combination of surgical intervention and antituberculous therapy, yielding favorable outcomes with minimal recurrence.

Conclusion: Early recognition and comprehensive management are crucial in isolated perianal tuberculosis to prevent recurrence and unnecessary surgical interventions. This case underscores the importance of considering tuberculosis in the differential diagnosis of perianal pathologies, particularly in TB-endemic regions like Tunisia. Prompt initiation of appropriate therapy is essential for favorable patient outcomes.

Keywords: Anal fistula; Case report; Perianal tuberculosis; Recurrence; Surgery.

Publication types

Case Reports