Novel Insights 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 non-specific symptoms. This study aimed to investigate the spectrum of clinical presentations and outcomes of tuberculosis (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 patients (3%) undergoing hemodialysis (HD) were diagnosed with TB from 200 being cared for in Madinat Zayed Hospital Al Dhafra, Abu Dhabi, UAE, Most had Extra-pulmonary involvement and a delayed diagnosis, all patient came from countries where TB is endemic, First line anti-tuberculous medication proved safe and effective in all cases We report these cases as an important reminder to clinicians to be aware that body fluids are may not initially provide positive results for AFB smear, culture or PCR, additionally, the tuberculin PPD skin test (TST), the classic diagnostic tool for LTBI, has several major drawbacks, including poor sensitivity (because of a high prevalence of anergy in dialysis patients). Although all patients’ microbiology were negative, the diagnostic criteria included lymphocytic exudative fluid upon aspiration, response to empirical anti-tuberculous treatment and in selected patients, tissue diagnosis was obtained. Conclusion Tuberculosis 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.