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Background <p>Perianal tuberculosis (TB) is an uncommon form of extrapulmonary TB, accounting for approximately 0.7% of all cases. Its nonspecific presentation and resemblance to other chronic perianal inflammatory or infectious conditions often delay diagnosis, occasionally resulting in rare complications such as coccygeal osteomyelitis.</p> Case Presentation <p>We report the case of a 56-year-old male with a long-standing history (twelve years) of recurrent perianal fistulas, ultimately diagnosed with perianal TB. After four years of his first presentation, one biopsy revealed a few non-caseating granulomas, negative for acid-fast bacilli (AFB) and other special stains, suggesting possible Crohn’s disease or an infectious aetiology. No evidence of systemic TB was detected on subsequent evaluations, including sputum polymerase chain reaction (PCR) and imaging studies, and there were no clinical features consistent with Crohn’s disease. After nine years, the patient developed coccygeal granulomatous osteomyelitis, which was also negative for AFB, mycobacterial culture, and tissue PCR. Following a significant recurrence of perianal symptoms, including deep circumferential ulcers and seropurulent discharge, a tissue-based PCR assay finally confirmed the presence of Mycobacterium tuberculosis (M. tuberculosis). The patient was started on standard anti-tubercular therapy, leading to substantial resolution of symptoms and complete fistula healing over several months.</p> Conclusions <p>Perianal TB may occasionally extend beyond the soft tissues to involve adjacent bones, resulting in destructive skeletal complications such as coccygeal osteomyelitis. Increased clinical awareness, early multidisciplinary evaluation, and repeated tissue-based PCR testing, particularly in TB-endemic regions, are essential for accurate diagnosis and favorable outcomes. This is especially important because conventional diagnostic methods, including AFB staining, mycobacterial culture, and even PCR, have inherent limitations in paucibacillary lesions, with a considerable false-negative rate and reduced sensitivity.</p>

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Perianal Tuberculosis Presenting as a Persistent Fistula Complicated by Coccygeal Osteomyelitis: Case Report and Literature Review

  • 期刊论文

  • 发表日期：

    2025年12月19日

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  • Ayat Al-Oqaily,
  • Sura AlOmari,
  • Anwar Rjoop,
  • Suhel Batarseh,
  • Sara Abusini,
  • Dua Abuquteish

摘要

Background

Perianal tuberculosis (TB) is an uncommon form of extrapulmonary TB, accounting for approximately 0.7% of all cases. Its nonspecific presentation and resemblance to other chronic perianal inflammatory or infectious conditions often delay diagnosis, occasionally resulting in rare complications such as coccygeal osteomyelitis.

Case Presentation

We report the case of a 56-year-old male with a long-standing history (twelve years) of recurrent perianal fistulas, ultimately diagnosed with perianal TB. After four years of his first presentation, one biopsy revealed a few non-caseating granulomas, negative for acid-fast bacilli (AFB) and other special stains, suggesting possible Crohn’s disease or an infectious aetiology. No evidence of systemic TB was detected on subsequent evaluations, including sputum polymerase chain reaction (PCR) and imaging studies, and there were no clinical features consistent with Crohn’s disease. After nine years, the patient developed coccygeal granulomatous osteomyelitis, which was also negative for AFB, mycobacterial culture, and tissue PCR. Following a significant recurrence of perianal symptoms, including deep circumferential ulcers and seropurulent discharge, a tissue-based PCR assay finally confirmed the presence of Mycobacterium tuberculosis (M. tuberculosis). The patient was started on standard anti-tubercular therapy, leading to substantial resolution of symptoms and complete fistula healing over several months.

Conclusions

Perianal TB may occasionally extend beyond the soft tissues to involve adjacent bones, resulting in destructive skeletal complications such as coccygeal osteomyelitis. Increased clinical awareness, early multidisciplinary evaluation, and repeated tissue-based PCR testing, particularly in TB-endemic regions, are essential for accurate diagnosis and favorable outcomes. This is especially important because conventional diagnostic methods, including AFB staining, mycobacterial culture, and even PCR, have inherent limitations in paucibacillary lesions, with a considerable false-negative rate and reduced sensitivity.