TUBERCULOUS ANAL FISTULA IN ACQUIRED-IMMU NODEFICIENCY-SYNDROME

We report here on a 36-year old, HIV-positive patient, who was sent to hospital with an anal fistula. A short time later during the course o f an extensive diagnosis the anal fistula was recognized as an extrapu lmonary manifestation of a miliary tuberculosis stemming from an immun odeficiency syndrome. A rapid conversion of the sputum, a normalizatio n of the radiological findings and the absence of relapse are the resu lts of the classic systemic fourfold therapy with myambutol, isoniazid , rifampicin and streptomycin. The danger of overlooking the fact that an anal fistula can be the clinically primary manifestation of a tube rculosis and the problems of a mixed infection within the scope of the acquired immunodeficiency syndrome are discussed. Tuberculosis as a f requent complicating infection of HIV-positiv patients - often diagnos ed some time before the AIDS-infection as in our patient - can be succ essfully cured by a high dose of intravenous pharmacotherapy, even whe n additional complications (parasitic stomatitis, increasing deteriora tion of the immunological parameters) are present. In order to show th e large spectrum of the problems involved in the diagnosis, the therap y and the course of the active acquired immunodeficiency syndrome, we have focused here on the detailed description of the case report.