Ann Dermatol.  2009 Nov;21(4):443-446. 10.5021/ad.2009.21.4.443.

A Case of Tuberculosis Cutis Orificialis with Perianal Involvement

• Choi SR
• Kim JK
• Kim DH
• Yoon MS

• KMID: 2156518
• DOI: http://doi.org/10.5021/ad.2009.21.4.443

Abstract

Tuberculosis cutis orificialis (TCO) is a rare manifestation of cutaneous tuberculosis that is caused by auto-inoculation of mycobacteria in patients with advanced internal tuberculosis. TCO occurs in oral, perianal, or genital mucosa and adjacent skin. The tongue is the most frequently affected site, but the perianal area can also be affected. A 39-year-old male presented with a 4-month history of painful ulcers on the perianal area. The histopathologic findings revealed granulomatous infiltrates composed of epithelioid cells and Langhans-type giant cells in the dermis, and a few acid-fast bacilli noted on Ziehl-Neelsen staining. The polymerase chain reaction (PCR) was positive for Mycobacterium tuberculosis and the chest X-ray showed findings consistent with active pulmonary tuberculosis in both upper lung zones. The skin lesion showed complete resolution 2 months after the start of treatment with antituberculosis agents. We report a case of TCO with perianal involvement in a patient with underlying active pulmonary tuberculosis.

Keyword

Perianal tuberculosis; Tuberculosis cutis orificialis

MeSH Terms

Adult
Dermis
Epithelioid Cells
Giant Cells, Langhans
Humans
Lung
Male
Mucous Membrane
Mycobacterium tuberculosis
Polymerase Chain Reaction
Skin
Thorax
Tongue
Tuberculosis
Tuberculosis, Cutaneous
Tuberculosis, Pulmonary
Ulcer

Figure

• 

  Fig. 1 (A) Several sharply demarcated ulcerations with erythematous indurated borders and purulent bases in the perianal area. (B) Chest x-ray film showing multiple ill-defined nodular opacities in both upper lung zones.

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  Fig. 2 Histopathologic examination of the margin of the ulcer revealed (A) granuloma composed of epithelioid cells and Langhans-type giant cells (H&E, ×200) and (B) caseous necrosis (H&E, ×200). (C) A few acid-fast bacilli were seen in the granuloma (Ziehl-Neelsen stain, ×400).

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