COMPLEX PERIANAL FISTULA AS A MANIFESTATION OF TUBERCULOSIS: CASE REPORT

We present the case of a 45-year-old immunocompetent patient with a history of recurrent anal fistula, who underwent anal fistulectomy in two stages, with an extension of the fistula into the scrotal sac. Magnetic resonance imaging revealed an inflammatory fistulous collection occupying the posterolateral aspects of the perianal compartment extending towards the left ischioanal fat, characterizing a perianal fistula. Histopathological examination demonstrated inflammatory changes, an infiltrate of inflammatory cells, lymphocytes, plasma cells, and epithelioid cells, as well as fibrosis. During re-surgical intervention due to wound healing failure, material was collected for tuberculosis culture, which confirmed the diagnosis. Gastrointestinal tuberculosis is a rare condition, affecting less than 1% of individuals, with anorectal involvement being even rarer, occurring in only 1% of cases of digestive tract tuberculosis. This case emphasizes the importance of considering tuberculosis as a differential diagnosis in recurrent anal lesions or those with poor healing, especially in endemic regions with significant rates of incidence of this disease.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
25 April 2025