A pain in the rear

Abstract

Tuberculosis is an endemic disease in Senegal. Cutaneous forms are rare and are characterized by their clinical polymorphism. They account for 2% of the extrapulmonary locations of tuberculosis [1, 2]. We report an observation of a tuberculous gumma of the buttock that led to the discovery of an active pulmonary localization in an immunocompetent adult. A 47-year-old man was admitted for a painful swelling of the right buttock that had been developing for four years. The physical examination noted an indurated, multinodular, and polyfistulized plaque, with confluent yellowish pus emission, on the inferomedial face of the right buttock, associated with bilateral inguinal lymphadenopathy. Cutaneous tuberculosis was found in the histology, which showed TB granuloma, and the gastric tube fluid was positive for acid-fast bacilli. Thoracoabdominopelvic CT showed multiple basal acinar micronodules in both lungs. Serology was negative for both HIV and HBV. All signs of tuberculosis disappeared after six months of treatment. In endemic zones, cutaneous tuberculosis is characterized by its clinical polymorphism. It must also be looked for in any perineal abscess. Early management greatly improves the prognosis.

Keywords: Senegal; buttock; tuberculous gumma.