Primary Perianal Tuberculosis in a Diabetic Patient
A 52-year-old man presented with acute perianal abscess with ulcerated and indurated edges. The lesion developed as an insidious onset of 1 month duration. The patient is a known case of diabetes for last 5 years and he is on anti-diabetic treatment. There was no past history or family history suggestive of tuberculosis. Local examination of anus showed a 2 cm × 1 cm swelling with posterior ulceration and irregular margin. Per rectal examination and colonoscopy revealed no abnormality. Laboratory findings including, routine hematological parameters, biochemical parameters (renal function test and liver function test), and urine biochemical findings were normal. Erythrocyte sedimentation rate (ESR) was mildly raised to 25 mm/h. Radiological tests like chest X-ray, abdominal contrast computed tomography were normal. Sputum smear examination on three consecutive days was negative for acid fast bacilli. Histopathological examination of biopsy from the edge of lesion revealed organizing inflammatory granulation tissue, areas of caseating necrosis and scattered epithelioid histiocytes. EZN staining was positive for acid fast bacilli []. Polymerase chain reaction (PCR) of biopsy material was positive for mycobacterium tuberculosis. The patient was put on anti-tubercular treatment for 6 months and the lesion healed completely without any recurrence in 1 year of follow-up.