Anorectal Tuberculosis Mimicking Anal Carcinoma

Le résumé fourni par la source

Purpose: Anorectal Tuberculosis is a rare clinical variant of mycobacterium tuberculosis infection, once known as tuberculosis cutis orificialis. Patients often respond to anti-tuberculin therapy. Though uncommon, anal squamous cell carcinomas are often diagnosed by gross inspection of the anal canal, followed by biopsy confirmation and radiation therapy. Though treatment is markedly divergent, the clinical appearance of the two disorders is similar. Methods: a 54 yo Pakistani gentlemen who presented initially to the primary care physician with complaints of an anal-rectal ulcer with pus and bleeding noted on defecation for 2–3 months. The patient denied any fever, chills, hemoptysis, diarrhea, constipation, abdominal pain, or weight lost. He denied any prior pulmonary disease, and had never undergone a screening colonoscopy. The patient had been in the United States for more than 20 years but visited Pakistan often. His last PPD was 2 years prior and negative. There were no prior hospitalizations or surgeries, no medications. There was no alcohol, tobacco or illicit drug use. Physical examination was significant for a fleshy linear ulceration at right posterior region of the anus. Results: Colonoscopy and small bowel series to rule out Crohn's disease and other colorectal involvement was normal. Multiple biopsies were taken of the ulcerated site which was limited to the anal canal. Biopsy revealed granulomas and acid fast bacilli identified as mycobacterium tuberculosis. Subsequently patient was sent to pulmonary clinic where a PPD was read as 20 mm induration and chest x-ray showed RLL infiltration. The patient was started on four drug tuberculosis regimen. Within 4 weeks, cutaneous and pulmonary findings resolved. Conclusion: Although tuberculous anorectal ulcer is rare, especially in the United States, this case shows the importance of considering the diagnosis in persons presenting with these findings, especially immigrants from endemic areas.Figure: Colonoscopy: Normal ileum, rectal ulcer. Anoscope: Linear fleshy ulceration.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.