Intestinal Tuberculosis With Recurrent Gluteal Abscesses and Perianal Fistulas: A Case Report and Literature Review.

IF 1 Q3 MEDICINE, GENERAL & INTERNAL
Cureus Pub Date : 2024-12-27 eCollection Date: 2024-12-01 DOI:10.7759/cureus.76456
Igor Takakazu Ribas Asato, Nayane Souza Novaes Asato, Fernanda Amariz Yamamoto, Ana Caroline Ferreira Siqueira, Anderson M Pereira da Silva
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Abstract

This case is relevant for describing a rare presentation of intestinal tuberculosis with perianal manifestations, complicated by abscesses and recurrent fistulas. The clinical manifestations mimicked Crohn's disease and other inflammatory conditions, making the diagnosis challenging and requiring a differentiated and meticulous diagnostic process. A 45-year-old male patient presented with a chronic abscess in the left buttock lasting for two years, characterized by spontaneous purulent drainage and multiple recurrences despite surgical and clinical treatments. Imaging findings revealed associated fistulous lesions, initially interpreted as possible inflammatory complications. The definitive diagnosis was confirmed as intestinal tuberculosis with perianal involvement through colonoscopy and biopsy, which revealed caseating granulomas. Treatment included a standard antituberculous regimen (rifampin, isoniazid, pyrazinamide, and ethambutol), along with antibiotics and antifungal agents for secondary infections. Adherence to treatment was satisfactory, with progressive improvement in the fistulas. This case highlights the importance of a comprehensive differential diagnosis in extrapulmonary tuberculosis, especially with unusual manifestations. Multidisciplinary management was essential for therapeutic success and the prevention of recurrences.

肠结核合并复发性臀脓肿及肛周瘘1例报告及文献复习。
本病例描述了一例罕见的肠结核伴肛周表现,并发脓肿和复发性瘘管。临床表现与克罗恩病和其他炎症状况相似,使得诊断具有挑战性,需要鉴别和细致的诊断过程。患者男,45岁,左臀部慢性脓肿2年,经手术及临床治疗后,自发性脓性引流,多次复发。影像学结果显示相关的瘘管病变,最初解释为可能的炎症并发症。通过结肠镜检查和活检,最终诊断为肠结核伴肛周受累,显示干酪样肉芽肿。治疗包括标准的抗结核方案(利福平、异烟肼、吡嗪酰胺和乙胺丁醇),以及用于继发性感染的抗生素和抗真菌药物。治疗依从性令人满意,瘘管逐渐改善。本病例强调了对肺外结核进行全面鉴别诊断的重要性,尤其是有异常表现的肺外结核。多学科管理对治疗成功和预防复发至关重要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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