Anorectal Tuberculosis Presenting With Multiple Abscesses and Fistulas in a Young Adult Male Patient With Alcohol Use Disorder: A Case Report

Gastrointestinal tuberculosis (TB) is an uncommon form of extrapulmonary TB, with anorectal involvement representing an exceedingly rare subset. We report a fatal case of disseminated anorectal TB in a 28-year-old male immigrant from Kenya with a history of alcohol use disorder, a recognized risk factor for TB reactivation and spread. The patient initially presented with rectal pain and perirectal purulent discharge. On evaluation, he was found to have a left perirectal abscess, a right ischioanal abscess, and multiple fistulas. Acid-fast bacillus staining of debrided anorectal abscess fluid revealed Mycobacterium tuberculosis complex, with additional evidence of pulmonary involvement on chest imaging and bronchoalveolar lavage, consistent with disseminated TB. The patient was initiated on anti-TB treatment with rifampin, isoniazid, pyrazinamide, and ethambutol. However, his condition rapidly deteriorated as he developed acute respiratory distress syndrome and septic shock, ultimately resulting in his death. This case highlights the rarity and potential severity of anorectal TB in disseminated disease. We also emphasize the importance of considering TB in patients with persistent or atypical anorectal infections, particularly those with epidemiologic risk factors such as prior residence in TB-endemic regions and alcohol use disorder.