Li Guo, Yuan Shan, Wang Peng, Pang Min, Pang Xianqiong
Department of Respiratory and Critical Care Medicine, Xichong County People's Hospital, Nanchong, Sichuan 637200, China.
Department of Nephrology, Xichong County People's Hospital, Nanchong, Sichuan, China.
IDCases. 2025 May 8;40:e02246. doi: 10.1016/j.idcr.2025.e02246. eCollection 2025.
A 56-year-old man with polycystic kidney disease (PKD) and end-stage renal disease (ESRD) on long-term hemodialysis presented with decreased appetite, malaise, cough and fever. Chest CT revealed a nodular reverse halo sign (NRHS), a rare but relatively specific feature associated with pulmonary tuberculosis (TB). Although conventional sputum smears were negative for acid-fast bacilli, was identified in bronchoalveolar lavage fluid through Xpert MTB/RIF testing and targeted next-generation sequencing. This case highlights: (1) NRHS as a significant radiologic indicator of TB, even in immunocompromised patients; (2) the need for advanced diagnostic tools when conventional tests are inconclusive; and (3) the impact of economic barriers in resource-limited settings, which can delay treatment and contribute to poor outcomes. Timely TB screening and accessible treatment are essential for high-risk populations, particularly those undergoing hemodialysis.
一名56岁患有多囊肾病（PKD）且处于终末期肾病（ESRD）并长期接受血液透析的男性，出现食欲减退、不适、咳嗽和发热症状。胸部CT显示有结节状反晕征（NRHS），这是一种与肺结核（TB）相关的罕见但相对特异的特征。尽管传统痰涂片抗酸杆菌检查为阴性，但通过Xpert MTB/RIF检测和靶向新一代测序在支气管肺泡灌洗液中检测到了结核菌。该病例强调了：（1）NRHS作为结核病的重要影像学指标，即使在免疫功能低下的患者中也是如此；（2）当传统检查结果不明确时，需要先进的诊断工具；（3）资源有限环境中经济障碍的影响，这可能会延迟治疗并导致不良后果。及时的结核病筛查和可及的治疗对于高危人群至关重要，尤其是那些接受血液透析的人群。
