title: Anal fistula: an unusual presentation of tuberculosis in a migrant health care professional.
abstract: We present a case of a young health care professional from the Indian subcontinent, who presented with a low anal fistula and underwent exploration, debridement and fistulotomy twice. The initial working diagnosis was Crohn's disease. However, Mycobacterium tuberculosis, fully sensitive to all first-line drugs was cultured from the specimens sent from the second surgical procedure. On initiation of anti-tubercular therapy the symptoms improved within 5 weeks. The origin of the patient, high index of suspicion for non-infectious reactivation of tuberculosis in migrant health care workers, importance of a proper history taking including previous exposure and diagnostic workup is stressed.
authors.affiliation: Department of Medicine, St. James’s Hospital, Dublin, Ireland. debmolloy@eircom.net
authors.forename: D
authors.initials: D
authors.lastname: Molloy
authors.forename: M K
authors.initials: MK
authors.lastname: Sayana
authors.forename: J
authors.initials: J
authors.lastname: Keane
authors.forename: B
authors.initials: B
authors.lastname: Mehigan
mesh_terms: D000328:Adult; D006282:Health Personnel; D006801:Humans; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification*; D012003:Rectal Fistula / Q000382:microbiology* / Q000601:surgery; D014171:Transients and Migrants; D014376:Tuberculosis / Q000175:diagnosis* / Q000188:drug therapy*