Objective: To summarize the clinical, electrophysiological, and sural nerve pathological features of patients who developed peripheral neuropathy during tuberculosis treatment, and to explore the pathological patterns of nerve injury and their value in differential diagnosis. Methods: The clinical data, neuroelectrophysiological findings, sural nerve pathological features, and follow-up outcomes of 10 patients who developed peripheral neuropathy during tuberculosis treatment and underwent sural nerve biopsy at the Eighth Medical Center of Chinese PLA General Hospital between February 2022 and May 2024 were retrospectively analyzed. Results: Among the 10 patients, 4 were male and 6 were female, with an age at onset ranging from 23 to 69 years. Peripheral neuropathy usually developed several weeks to several months after the initiation of anti-tuberculosis treatment. The main clinical manifestations were distal numbness, pain, and weakness of the limbs, and 7 patients had grade 3-4 peripheral neuropathy according to the National Cancer Institute Common Terminology Criteria for Adverse Events. Neuroelectrophysiological studies showed sensorimotor mixed peripheral nerve involvement in all patients, predominantly characterized by axonal injury, with conduction slowing and late-response abnormalities in some cases. Sural nerve biopsy revealed varying degrees of myelinated fiber loss and axonal degeneration in all cases, with regeneration, myelin abnormalities, microvascular changes, or mild inflammatory cell infiltration in some cases. No typical tuberculous granuloma, caseous necrosis, or positive acid-fast staining was observed. Mycobacterium tuberculosis nucleic acid testing was positive in 1 case. Most patients showed limited neurological recovery during follow-up. Conclusions: Peripheral neuropathy occurring during tuberculosis treatment is pathologically characterized predominantly by axonal injury, with variable myelin changes, microvascular abnormalities, and mild inflammatory cell infiltration. Most cases showed no pathological evidence of typical direct tuberculous invasion of the peripheral nerve, suggesting that this condition may represent a heterogeneous injury process involving multiple factors in the context of tuberculosis infection. Sural nerve biopsy is useful for identifying pathological injury patterns and provides evidence for differential diagnosis in complex etiological settings.
患者女性，51岁，诊断系统性红斑狼疮12年，长期服用糖皮质激素治疗。以急性进行性发展的高热、腰背痛起病；影像学检查显示全身播散性骨病灶，高度提示恶性肿瘤；但多次病灶活检均未确诊肿瘤。通过病原体高通量测序，最终在骨髓中检测出结核分枝杆菌复合群DNA。经过足疗程的四联抗结核治疗，患者的发热及腰背痛逐渐缓解。急性全身播散性骨关节结核病例极为罕见，常规胸片和分子筛查手段难以早期诊断。通过本例诊疗过程提示临床医生，影像学检查在判断病变性质方面的局限性，并强调结核感染病灶在影像学检查中误诊恶性肿瘤的可能，以及在获取体液或组织标本时同时开展分子病原体检测的重要性。
重症超声无创、床旁、实时、可视化的优势，使其成为重症监护病房（ICU）精准诊疗的核心支撑技术。重症相关新认知的提出，促进重症超声在危重患者诊疗中逐渐凝练为五大核心应用场景：（1）重症超声可视化查房；（2）新入ICU患者重症超声可视化评估；（3）精细化及重症问题导向的重症超声可视化评估；（4）基于重症超声的可视化远程查房；（5）重症超声可视化引导操作。本文结合重症新认知，对重症超声在五大核心场景中的实施方案及临床应用研究进展进行系统综述，为重症超声在重症患者诊疗高效精准应用提供参考。
肾上腺血管瘤为罕见肾上腺良性病变，多无内分泌活性。本文报道1例55岁男性患者，因腹部不适就诊，影像学见异位右肾上腺区肿物，伴高血压、低血钾及醛固酮异常，术前拟诊异位醛固酮瘤。手术切除后病理证实为肾上腺血管瘤，术后醛固酮、血钾快速恢复正常。本病例提示肾上腺血管瘤极为罕见，临床可表现为原发性醛固酮增多症，但诊断需以术后病理为确诊依据。
Autoimmune bullous diseases (AIBDs) are a group of organ-specific autoimmune disorders caused by autoantibodies directed against skin adhesion structures. Their diagnosis and treatment heavily rely on accurate autoantibody testing. To address current challenges in China, such as the diversity of AIBDs testing methods and lack of standardization, the National Clinical Research Center for Rheumatic and Autoimmune Diseases (Peking Union Medical College Hospital) initiated the development of this guideline. In collaboration with the Key Laboratory of Rheumatology and Immunology of the Ministry of Education, National Professional Healthcare Quality Control Center for Immunology (Including Allergy), Rheumatology and Immunology Physician Committee of Chinese Medical Doctor Association, and Rheumatology Society of Chinese Medical Association, a multidisciplinary expert working group was established. Based on the latest international evidence and clinical practice in China, the group formulated this guideline by strictly adhering to evidence-based guideline development methods and procedures. This guideline focuses on eight key issues related to laboratory testing for AIBDs in China. It covers the application of autoantibodies in the diagnosis, subtyping, disease assessment, treatment guidance, identification of applicable populations, determination of testing timing, result interpretation, and quality management of AIBDs. The aim is to enhance the laboratory's capabilities in autoantibody testing and result interpretation, and offer important references for advancing precision diagnosis and treatment of the disease.
