Tuberculosis cutis orificialis with perianal involvement

A 25-year-old man, a lifelong resident of Rio de Janeiro, presented with a 3-month history of a painful ulcer in the perianal region, fatigue, and evening fever. He had no history of cough, weight loss, altered bowel habits, or other comorbidities, or any relevant family history. He was a smoker with a history of high alcohol intake. Physical examination (Figure 1) revealed a tender fusiform ulcer in the perianal region, 2 cm in diameter, with erythematous indurated borders and a clean and friable base, without signs of inflammation or satellite lymph node enlargement. A spindle cutaneous biopsy was performed of the center and border of the ulcer for histopathological analysis, which revealed only dermal fibrosis. HIV, and hepatitis B and C serology, and quantitative VDRL were negative. Chest computed tomography showed an infiltrate with a characteristic “tree-in-bud” pattern (Figure 2) and the diagnosis of pulmonary tuberculosis was confirmed by sputum culture. Ulcer tissue tested positive for Mycobacterium tuberculosis on GeneXpert and culture, despite the lack of alcohol-acid bacilli. The patient was diagnosed with perianal cutaneous tuberculosis concomitant with pulmonary tuberculosis. He was treated with rifampicin, isoniazid, pyrazinamide, and ethambutol for 2 months; followed by rifampin and isoniazid for the following 4 months. By the end of the second month, the perianal lesion had healed (Figure 3). This report describes a rare form of cutaneous tuberculosis in an immunocompetent young man, and illustrates the importance of molecular methods (GeneXpert) for making the diagnosis^1,2,3.

FIGURE 1:
Perianal ulcer.

FIGURE 2:
Chest tomography: “tree-in-bud pattern” (red circle).

FIGURE 3:
Perianal ulcer before (left) and after (right) 2 months of treatment.

ACKNOWLEDGMENTS

We offer our deepest thanks to the institutions that provided technical support for the development and implementation of this study.

REFERENCES

• ¹
  Brito AC, Oliveira CMM, Unger DA, Bittencourt MJS. Cutaneous tuberculosis: epidemiological, clinical, diagnostic and therapeutic update. An Bras Dermatol. 2022;97(2):129-44.
• ²
  Dey B, Deshpande AH, Bhat SH, Singh A. Tuberculosis cutis orificialis with underlying pulmonary tuberculosis in an immunocompetent man. J Lab Physicians. 2018;10(4):457-9.
• ³
  Lima T, Belotti N, Nardi S, Pedro H. Teste rápido molecular GeneXpert MTB/RIF para diagnóstico da tuberculose. Revista Pan-Amazônica de Saúde. 2017;8(2):65-76.

• Financial Support: There was no financial support.

Publication Dates

• Publication in this collection
  24 July 2023
• Date of issue
  2023

History

• Received
  13 Apr 2023
• Accepted
  23 June 2023