Extra pulmonary tuberculosis accounts for less than 15% of all cases of tuberculosis whereas the Intestinal one constitutes less than 1% of the extrapulmonary forms of the disease. The lesions of abdominal organs are more common while they rarely occur in the anoperineal area for the spread of the disease to the anus is extremely rare. We report a case of a 37-year-old male patient with large bilateral infected perianal tubercular ulcerations as well as pulmonary and peritoneal tuberculosis. The treatment was both surgical and medical and the therapy lasted for seven months. After six months from the beginning of the treatment, the lesion had totally disappeared and there is still no recurrence after one year of followup. Tuberculosis should generally be taken into consideration in the differential diagnosis of the ulcerative lesions of the anal and perianal regions for these lesions do occur in the said areas despite their rarity. The treatment is usually both surgical and medical so as to get excellent results. 1. Introduction Extra pulmonary tuberculosis or (TB) accounts for less than 15% of all cases of tuberculosis [1, 2], while the intestinal one constitutes less than 1% of extrapulmonary forms of the disease [3]. The lesions of abdominal organs are more common while the anoperineal localization rarely occurs. Symptoms and signs of anal pain or discharge, as well as multiple or recurrent fistula in ano and perineal ulcerations, are not characteristically distinct from other anal lesions especially in Crohn’s disease. In addition, tuberculosis of the gastrointestinal tract usually occurs as a result of a spread from tuberculosis foci in the lungs. Ingestion of the bacilli from sputum may lead to invasion of the intestinal wall. Positive diagnosis of anal TB relies on both histological and bacteriological assessments. Polymerase chain reaction (PCR) and culture confirm the diagnosis of TB as well. 2. Clinical Observation A 37-year-old male patient was admitted with a history of perianal discharge and ulceration for the last four months. According to his medical history, he was treated for a perianal abscess which was incised and drained one year ago, yet, despite the initial healing, it recurred two months later. During the clinical examination at the admission, the patient, with a weight of 40？kg was relatively dehydrated and had tachycardia (pulse rate, 110/min). Physical examination revealed body temperature 38,5°C, and arterial pressure of 09/06？mmhg. No lymphadenopathy was found on palpation; in addition abdominal examination revealed a
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