Occult Tuberculosis in Dialysis Patients Is Rarely Straightforward: Retrospective Case Series

The diagnosis of tuberculosis (TB) in dialysis patients may be difficult because of the increased frequency of extra-pulmonary presentations, atypical clinical manifestations, and nonspecific symptoms. This study aimed to investigate the spectrum of clinical presentations and outcomes of TB in dialysis patients in a retrospective case series and data analysis over a 14-year period between 2011 and 2024.

A total of 6 (3%) patients undergoing hemodialysis were diagnosed with TB from 200 being cared for in Madinat Zayed Hospital Al Dhafra, Abu Dhabi, UAE. Most had extrapulmonary involvement and a delayed diagnosis, and all patients came from countries where TB is endemic. The first-line antituberculous medication proved safe and effective in all cases. Additionally, we report these cases as an important reminder to clinicians to be aware that body fluids may not initially provide positive results for acid-fast bacilli smear, culture or polymerase chain reaction test polymerase chain reaction, additionally, the tuberculin PPD skin test (TST), the classic diagnostic tool for latent TB infection, has several major drawbacks, including poor sensitivity (because of a high prevalence of energy in dialysis patients). Although all patients' microbiology were negative, the diagnostic criteria included lymphocytic exudative fluid upon aspiration, response to empirical antituberculous treatment and in selected patients, tissue diagnosis was obtained.

TB should be strongly considered in dialysis patients from endemic regions presenting with unexplained inflammatory syndromes or serosal effusions, even when microbiological tests are negative. Early empirical treatment can be both diagnostic and life-saving.