This is an anal smear (Ziehl Neelson) from an immunocompromised male with miliary TB. Numerous intracellular acid fast positive organisms are seen.
Under oil, the acid-fast bacilli are visible with Ziehl-Neelsen stain.
Tuberculosis remains a problem worldwide, especially in certain developing countries. Anoperineal disease is a fairly uncommon manifestation of tubercular infection. Anal TB may arise from hematogenous spread, swallowing sputum containing large amounts of mycobacteria from an active pulmonary focus and direct extension from adjacent organs (Gupta).
The different morphological forms of anal TB include ulcerative, verruous, lupoid and miliary, with the ulcerative form the most prevelant. It shows superficial ulceration, with a hemorrhagic necrotic base covered by thick purulent secretions of mucous.
Predominantly affects males (M:F ratio of 4:1) in their 4th decade and usually, a co-existing pulmonary lesion is present. Clinical presentation includes anal pain and a suppurative/ulcerative lesion, mimicking Crohns disease. Diagnosis may be difficult as the lesion mimics neoplasm or other processes, requiring a high index of suspicion.
Multidrug regimen is employed, which may be modified depending on resistance patterns.
Gupta PJ. Ano-perianal tuberculosis - solving a clinical dilemma. Afr Health Sci. 2005 December; 5(4): 345–347.
Mathew S. Anal tuberculosis: Report of a case and review of literature. International Journal of Surgery (2008) 6, e36-e39.