关键词: 血液和淋巴系统疾病, 肾透析, 结核, 治疗结果

Abstract:

Objective: To report the diagnosis and treatment process of a patient on maintenance hemodialysis (MHD) complicated with cervical tuberculous lymphadenitis, and to analyze the clinical features, diagnostic approach, treatment strategy, and prognosis of this condition by reviewing relevant literature. Methods: We conducted literature research using the keywords “hemodialysis” and “tuberculosis” in PubMed, CNKI, and Wanfang databases for paper published from January 2005 to May 2025, retrieved 41 articles involving a total of 70 extrapulmonary tuberculosis cases. Ultimately, 6 cases (including the present case) receiving maintenance hemodialysis (MHD) complicated with tuberculous lymphadenitis with complete clinical data were included for literature review and analysis. We then summarized the characteristics of this case and reviewed the literature on the included cases. Results: This patient with MHD complicated with cervical tuberculous lymphadenitis was a middle-aged to elderly male with a history of diabetic nephropathy. The patient was admitted due to acute heart failure, and during treatment, painless cervical lymphadenopathy was detected. Ultrasound-guided needle biopsy revealed pathology consistent with “chronic granulomatous inflammation,” and nucleic acid amplification of the biopsy tissue was positive for Mycobacterium tuberculosis, confirming the diagnosis. Treatment consisted of a four-drug regimen including isoniazid (H), rifampicin (R), pyrazinamide (Z), and ethambutol (E). Based on his dialysis schedule, the dosing frequencies of pyrazinamide and ethambutol were adjusted to three times per week (administered post-dialysis). After two months of treatment, the patient’s cervical lymph nodes significantly decreased in size, his disease condition was effectively controlled. A review of the literature identified a total of 6 cases (including the present one) of MHD combined with tuberculous lymphadenitis with detailed clinical records. Their mean age was 52 years, with 3 males and 3 females. Diagnosis was primarily based on lymph node biopsy and molecular biological test. All patients achieved favorable therapeutic outcomes following individualized anti-tuberculosis treatment. Conclusion: MHD patients were at high risk of extrapulmonary tuberculosis due to immune dysfunction, and their clinical manifestations are often atypical. Diagnosis should combine imaging, immunological and pathological examinations. Treatment must follow guidelines strictly, with individualized adjustments (such as modifying drug dosage and administration frequency) to the standard regimen based on renal function and dialysis status.

Key words: Hemic and lymphatic diseases, Renal dialysis, Tuberculosis, Treatment outcome