Multidrug-Resistant Anal and Perianal Tuberculosis: A Case Report From the Pneumo-Phthisiology Department of Conakry University Hospital, Guinea.

INTRODUCTION

Multidrug-resistant (MDR) anal and perianal tuberculosis constitutes an exceptionally rare form of extrapulmonary tuberculosis. We report a case of MDR anal and perianal tuberculosis diagnosed and managed in the Pneumo-Phthisiology Department of Ignace Deen University Hospital in Conakry, Guinea.

CASE PRESENTATION: Mrs. M.B., a 33-year-old housewife residing in Tombolia (Conakry), with no notable medical history, presented to the General Surgery Department of Ignace Deen University Hospital on 24 February 2023 with fever, abdominal pain, constipation, and painful swelling of the anal and perianal region. Following a hemorrhoidectomy, histopathological examination of the surgical specimen initially suggested a diagnosis of diffuse large B-cell lymphoma of the anal region. Consequently, CHOP chemotherapy (Adriamycin, cyclophosphamide, vincristine, and prednisolone) was initiated on 10 March 2023 in the Hematology Department. After three cycles of chemotherapy, the patient showed no clinical improvement, with persistent anal lesions and recurrent fever. A strongly positive tuberculin skin test (15 mm) prompted referral to the Pneumo-Phthisiology Department for suspected anal tuberculosis. GeneXpert MTB/RIF testing performed on stool samples confirmed the presence of MDR Mycobacterium tuberculosis. A 9-month short-course second-line antituberculosis regimen was initiated. After 1 month of treatment, the patient developed abdominal pain, semiliquid diarrhea, anorexia, and abdominal distension with a positive fluid-thrill sign. The anal and perianal lesions, however, showed significant improvement.

CONCLUSION

MDR anal and perianal tuberculosis is an uncommon manifestation of extrapulmonary tuberculosis. In regions with high tuberculosis endemicity, it should be considered in the differential diagnosis of chronic ulcerative cutaneous or mucosal lesions. Management relies primarily on second-line antituberculosis therapy to prevent complications and ensure complete recovery.