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Tuberculosis is still a major health problem worldwide. It is one of the causes of granulomatous disease within the anorectal region. The clinical features, which include symptoms and signs of anal pain or discharge, multiple or recurrent fistula in ano and inguinal lymphadinopathy, are not characteristically distinct from other anal lesions. It is a rare extrapulmonary form of the disease that we must learn to recognize because it requires specific treatment. It is also difficult to distinguish it from other granulomatous diseases involving the same area. A Medline database was used to perform a literature search for articles relating to the term ‘anal’, ‘tuberculosis’ and ‘Koch’s’.
Analysis of the available literature shows that Koch’s lesion in and around the anus is not uncommon. The presentation is varied in nature and tuberculosis should be suspected in lesions not responding to the conventional approaches. The treatment is two-fold: surgical for the suppuration and medical for the tuberculosis.