A 38-year-old single woman had type 2 diabetes mellitus. Her current illness began 3 months prior with anal pruritus, with burning anal pain and bleeding. Two weeks later, perianal ulcers appeared with increased pain and bleeding (fig. 1). The patient applied lidocaine and hydrocortisone ointments with no improvement. She sought medical attention for this symptomatology, and due to the size and lateral location of the ulcers, they were biopsied. The histopathologic study reported the presence of Langhans giant cells and an intense granulomatous reaction (figs. 2 and 3). The PCR test was positive for tuberculosis. Ziehl-Neelsen staining was done and was positive for Mycobacterium tuberculosis (fig. 4).

Figure 1.

Atypical location of perianal ulcers of the patient.

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Figure 2.

Low-magnification photomicrograph (H&E) with granulomatous reaction and giant cells.

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Figure 3.

Medium-magnification photomicrograph (H&E) with Langhans giant cells.

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Figure 4.

High-magnification photomicrograph with Ziehl-Neelsen stain showing tubercle bacilli.

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The patient was treated with isoniazid, rifampin, pyrazinamide, and ethambutol for 2 months and then for 6 months more with isoniazid and pyrazinamide, resulting in symptom remission and cicatrization of the perianal ulcers.

Cutaneous tuberculosis is currently very rare and can present as lupus vulgaris, miliary lesions, erythema induratum of Bazin, abscesses, or ulcers. There are very few reported cases of perianal cutaneous tuberculosis.