Abstract:

Objective: To summarize the clinical characteristics of HIV-positive patients diagnosed with tuberculous pulmonary nodules after they received surgery due to pulmonary nodules and enhance the diagnosis and treatment capabilities for this group of population. Methods: A retrospective analysis was conducted in 129 HIV-positive patients who underwent lung resection for pulmonary nodules admitted to the Department of Thoracic Surgery of Shanghai Public Health Clinical Center from January 1, 2015 to July 1, 2024, of which 14 patients were confirmed to be pulmonary tuberculosis after surgery. The clinical data of those 14 patients, including demographic characteristics, medical history, laboratory examination results and imaging data, were collected and their clinical characteristics were analyzed. Results: Among 14 HIV-positive patients who were diagnosed as tuberculous pulmonary nodules after surgery, most of them (85.7%, 12/14) were asymptomatic and were found through physical examination. The CD4⁺ T lymphocyte count was less than 400 cells/μl in 10 patients, and the negative rate of IGRA test was higher (70.0%, 7/10). The main imaging findings were pulmonary nodules with a diameter of 11-20 mm (50.0%, 7/14), solid nodules (92.9%, 13/14), irregular shapes (71.4%, 10/14), and fuzzy boundaries (64.3%, 9/14). There were certain degrees of malignant morphological features, including spiculation (50.0%, 7/14), pleural traction or thickening (50.0%, 7/14), and positive functional imaging (64.3%, 9/14). Conclusion: Most of the patients with tuberculous pulmonary nodules and living with HIV have no obvious clinical symptoms before surgery. Their immunological testing for tuberculosis may have false-negative results influenced by the immune status. It’s a challenge to differentiate tuberculosis from malignant tumors by imaging features. Using comprehensive diagnostic methods for definite diagnosis is recommended.

Key words: HIV infections, Sarcoidosis, pulmonary, Pulmonary surgical procedures, Tuberculosis, Disease attributes