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#ItsTime A 37 y/o/m patient was admitted with a history of perianal discharge and ulceration for the last 4 months. According to his medical history, he was treated for a perianal abscess which was incised and drained 1 year ago, yet, despite the initial healing, it recurred 2 months later. No lymphadenopathy was found on palpation; in addition abdominal examination revealed a generalized tenderness. The perianal region examination showed large bilateral infected ulcerations followed by pus. The digital rectal one revealed no pathological findings except a slight sphincter hypotonia. Anoscopy was normal and no fistulas were noted. The rectosigmoidoscopy showed no abnormalities as well. Please help if its a case of TB?

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Bil upper lung field consists of fibroreticular parenchymal shadows seen. Left upper zonal fibrocavitatory lesion seen. Inhomogenous opacities seen in CT abd. Consider swab study of sinus discharge including CBNAAT and AFB culture and sensitivity test. Consider atypical mycobacterium complex as well. AKT may be 18 to 24 months. Optimum Treatment of MDR species as per sensitivity test.
* Tuberculosis Needs further investigation and evaluation tissue biopsy and culture with sensitivity. Debridement under LA or GA ASD with betadine lotion. ATT and regular evaluation and constant monitoring will give good results. Improve general health and personal hygiene. Good nutritious balanced diet. Multivitamin and antioxidants orally.
Thanks Dr Pushkar Bhomia
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Xray chest is post ICD status Which is seen in rt upper zone Lt apex is hazy and fibronodular cavity is seen Non healing ulcer perianal region recurrence Adv for tissue biopsy and c&s Followed by debridement and secondary healing Most likely tubercular perianal abscess post drained status Pt may require ATT
Thanx dr Ashok Leel
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? Tuberculosis Do CBNAAT, pus c/s & AFB, CBC, FBS, PPBS, Urea, Creatinine, LFT, Urinalysis Post the reports obtained for further discussions
NEED'S INVESTIGATIONS.. * HEMOGRAM.. * CBNAAT.. * PUS C AND S EXAMINATION.. * BSR..HBA1C.. * TRIDOT.. ? TUBERCULOSIS..
Tnx Dr Shivraj Tnx Dr Shivraj Agarwal sir
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Tubercular sinus or perianal ulcer , culture and sensitivity of the pus, rbs,tissue biopsy, AFB
Ad CBNAAT C/S of discharge After results of reports start treatment
Tubercular chest and abdomen
TB Ad dm htn The anal ulceration associated with nicorandil usually presents clinically with anal pain. Mucus discharge and rectal bleeding are less common. Anal ulceration usually occurs spontaneously but sometimes develops after anal trauma. ... After withdrawal of nicorandil, ulcer healing may take place in as little as two weeks.
Both lung apices show fibrobronchiectaic lesions, and cavity in left apex, suggestive of TB Suggest biopsy from edge of ulcer + AFB, CBNATT, from pus from ulcer . Likely to be TB fistula MRI of perineum is more accurate in demonstrating high colorectal fistula. IBD to be kept in mind .
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