28 y.o. male who recently underwent biopsy of a non-healing ulcer in the perianal region Pathology showed granulomatous inflammation and cultures have now isolated M. Tuberculsosis and referred to TB clinic.

3 months prior

Cough which started for about 8 months  which lasted approx a few weeks; non productive.

Cough resolved and then about 2 months later the cough recurred and was productive, which initially appeared to improve but now says over the past 2 months he has had a persistent cough, worse in the AM.

Sputum is brownish and thick in the AM and then later turns yellow. No blood

• Chest x-ray shows bilateral patchy opacities with multiple lesions that appear cavitary, consistent with pulmonary TB
• extrapulmonary disease involving the perianal area.
• Sigmoidoscopy  did not reveal any evidence of fistula.
• Given perianal ulcer, query extension from the rectum vs genitourinary tract despite lack of symptoms.
• HIV negative.
• 4+ smear positive and isolated M. TB

2 Months Later

 

1 Month Later

CAvitation Atelectasis Bronchovascular Involvement

Large cavitary lesion in the left upper lobe and a smaller cavitary lesionin the right upper lobe concerning for granulomatous
disease such as tuberculosis.

Additional numerous patchy nodular opacities in bilateral lungs as
described above with tree-in-bud appearance representing endobronchialspread .