Perianal tuberculosis in an HIV-positive patient.

A 29-year old bisexual man was referred to the TB/HIV clinic in the Tuberculosis and HIV/AIDS Department, National Research Institute for Tuberculosis and Lung Diseases in Tehran, with a non-healing perianal ulcer and purulent discharge from the anus accompanied by episodes of fever, chills and generalized weakness. The patient’s complaint had begun 3 years previously and had been diagnosed as anal fissure in another hospital. He underwent the surgical removal of the fissure 2 times before being admitted to the clinic. Nevertheless, ulcer and discharge recurred. No histopathology results were available from those operations. During that period, he received various antibiotic regimens for his illness without improvement. He was found to be HIV positive 5 months before admission. The patient is married and works as a welder. He had a positive history for opium abuse (opium smoking) and anal intercourse. Physical examination revealed a moderate tenderness in the epigastric and right upper quadrant region. A perianal sinus, 5 cm × 2 cm with a depth of 4 cm, opening into the right side of the anus without extension to the anal sphincter was seen at the 3 o’clock position with the patient in the lithotomy position. The ulcer was sur-