Anorectal tuberculous granuloma presenting with faecal incontinence

Tuberculosis is a common condition world-wide but more so in developing countries where it accounts for 95% of all cases. It primarily affects the respiratory system, but other systems including the gastro-intestinal tract can also be affected. When it does, it has predilection for the ileo-caecal region, where half of the cases occur. Ano-rectal tuberculosis is not very common and when it occurs, it could present as a mass, making it difficult to differentiate from malignancy and other granulomatous lesions. We therefore, present a case of a 68-year old man with a huge mass in the ano-rectum with faecal incontinence, which was clinically diagnosed as an advanced carcinoma of the ano-rectum for which the biopsy was reported as tuberculosis. He improved with anti-tuberculosis treatment.