Anal tuberculosis is an extremely rare extrapulmonary presentation of tuberculosis (TB). Less than 1% of the individuals who contract TB manifests as gastrointestinal TB, and anoperineal TB is much less frequently encountered, 1% of the TB cases of the digestive tract. A rare case of anal tuberculosis is reported in a 37-year-old male patient with a recent anal fistula surgery and relapsing anal lesions. AFB were detected by biopsy and culture. In total, the treatment course lasted 6 months and the patient showed signs of recovery in the early stages of the treatment (after 2 weeks), and complete remission was achieved. In conclusion, it is recommended that in case of encountering Non-healing and recurrent anal lesions, especially in regions endemic for TB, should be evaluated for tuberculosis.