The Indian Journal of Tuberculosis - LRS Institute of Tuberculosis ...

Case Report
TUBERCULOSIS IN PILONIDAL SINUS
Sachin S. Baldawa 1 , Chirag S. Desai 2 and Rajeev Satoskar 3
(Original received on 6.3.2006; Revised Version received on 24.4.2006; Accepted on 2.5.2006)
Summary: Pyogenic infection occurring in the pilonidal sinus is very common in young individuals with sedentary occupation.
Tuberculous infection of pilodinal sinus is extremely rare and restricted to a case report in the literature. We present a 68-yearold
male presenting with long standing pilonidal sinus with tuberculous infection. [Indian J Tuberc 2006; 53:161-162]
Key Words: Pilonidal Sinus, TB infection, granuloma.
INTRODUCTION
Tuberculosis is endemic in South Asian
countries. With the advent of pandemic of acquired
immuno-deficiency disease, tuberculosis is spreading
even in the western population. Tuberculosis has
been found at rare sites as exemplified by its rare
occurrence in pilonidal sinus 1 .
CASE REPORT
A 68 year old obese businessman presented
with a sinus in the intergluteal cleft with a nest of
hair within. Surrounding skin was normal. Clinical
diagnosis of pilonidal sinus was made. X-ray
lumbosacral spine was normal. Wide excision of
the sinus was done. Sinus was extending till the
subcutaneous tissue. Primary closure of the skin
was not possible due to a large raw surface area.
Post-operative recovery was uneventful.
Histopathology of the specimen on Hematoxylin
and Eosin stain revealed skin covered tissue with
pilosebaceous unit and sweat glands. Deep dermis
showed many calcified deposits, a few epithelioid
granulomas with caseation in centre with
Langhans’ giant cells suggestive of calcified
tuberculosis (Fig.). Tissue for Acid Fast Bacilli
staining was negative. No malignancy was
detected. Patient was started on four drug antituberculosis
therapy. Follow up after 5 months
showed wound healed with no recurrence.
DISCUSSION
Pilonidal sinus is subcutaneous tract with
tuft of hair within, occurring in late teens and adult
life. Commonest mode of presentation is chronic
discharging sinus, especially in patients having
sedentary occupation 2,3 .
Pilonidal sinus commonly gets secondarily
infected. Infection by pyogenic organisms is the
commonest 4 . Infection by other rare organisms are
Fig.: H and E stain showing tuberculous
epithelioid granuloma.
1. M.S Second year resident 2. M.S DNB Lecturer 3. M.S Professor
Department of Surgery, Seth G.S.Medical College and K.E.M.Hospital, Mumbai (Maharashtra)
Correspondence: Dr Sachin S Baldawa, Baldawa Hospital, Budhwar Peth, Near Kasturba Market, Solapur – 413002 (Maharashtra)
Indian Journal of Tuberculosis