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 (Figure 2, Figure 3). The PCR test was positive for tuberculosis. Ziehl-Neelsen staining was done and was positive for Mycobacterium tuberculosis (fig. 4).
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