A 25-year-old Chinese man presented with the edema of the lower limbs and kidney dysfunction two years ago. The patient was then diagnosed as IgA nephropathy, based on the pathologic result of renal biopsy. The serum creatinine level was 222 mumol/L at that time. One year ago, the serum creatinine was increased to more than 600 mumol/L and regular hemodialysis was initiated. The patient was admitted to our hospital in August 2020 for kidney transplantation. On admission, physical examination revealed that multiple lymph nodes were palpable on both sides of the neck, which were painless and mobile. The maximal one with a size of 5 cm x3 cm was on the right supraclavicular fossa of the neck. The tremor of the arteriovenous fistula for hemodialysis on the left forearm was well. The results of a routine peripheral blood test at the time of admission were as follows: hemoglobin 89 g/L, white blood cells 10.80 x 109/L, neutrophil percentage 83.4%, and platelets 490 x 109/L. The serum creatinine was 1429 mumol/L. The computed tomography (CT) scan of the chest and abdomen revealed two inflammatory small nodules of 0.3 cm in the lower lobes of both lungs and reduced sizes of both kidneys. Regular hemodialysis (three times per week) was performed. On the 3rd day after admission, the patient suffered from fever, with a temperature of 38.8 C. The repeated blood test results were as follows: hemoglobin 86 g/L, white blood cells 12.35 x 109/L, neutrophil percentage 77.9%, and platelets 474 x 109/L. The PCT level was 5.73 ng/mL and cefmetazole was prescribed. PCT was measured using the electrochemical luminescence method (VIDAS Brahms PCT, Mannheim, Germany) according to the manufacturer's instructions. On the 10th day after admission, the symptom of fever was not well controlled and the patient still suffered from intermittent fever, with a maximal body temperature of 39.9 C. The PCT increased to 26.7 ng/mL. Antibiotic was upgraded to meropenem accordingly. On the 12th day after admission, although the temperature dropped to below 38 C after adjusting the antibiotic, the PCT increased to 63.10 ng/mL, and the level of C-reactive protein (CRP) was 186.00 mg/L (normal range <5 mg/L). Vancomycin was added. On the 14th day after admission, the biopsy of the lymph node on the right supraclavicular fossa of the neck was performed. On the 17th day after admission, the body temperature dropped to the normal range and remained normal in the remaining duration of the hospital stay. The histopathology result of lymph node biopsy revealed as inflammatory necrosis with granulomatous formation (Figure 1). The acid-fast staining was positive and a small number of DNA fragments of Mycobacterium tuberculosis was detected by Tuberculosis (TB)-qPCR monitoring. On the 21st day after admission, an antituberculosis regimen consisting of isoniazid, rifapentine, ethambutol, and levofloxacin was started and the surgery for kidney transplantation was canceled. The PCT declined gradually to 4.18 ng/mL on the same day and the antibiotics were downgraded to Piperacillin-tazobactam. On the 24th day after admission, the PCT level, dropped to the lowest point in admission monitoring, at 2.9 ng/mL. After that, the PCT increased gradually to 39.4 ng/mL on the 41st day after admission. There was no fever, cough, diarrhea, abdominal pain, frequent urination, and painful urination et al. The count of white blood cells was 4.58x109/L. The level of IL-6 was 8.55 pg/mL (normal range 0-7 pg/mL) and the level of CRP was 11.1 mg/L. The antibiotics were upgraded to meropenem and vancomycin again with the antituberculosis regimen continued. However, there was no marked decline of serum PCT levels. On the 51st day after admission, the PCT level was 94.9 ng/mL. The count of white blood cells was 3.8x109/L. Twice blood cultures were performed and the results were negative. The parasite antigen test was negative. The echocardiography test showed no obvious abnormalities in cardiac structure or blood flow. The thyroid function was normal. The patient was present with no complaint and in good spirit. After another 21 days course of treatment with both meropenem and vancomycin, On the 61st day after admission, the PCT level was 42.6 ng/mL. The count of white blood cells was 3.91x109/L. The levels of IL-6 and CRP were in the normal range (3.02 pg/mL and 4.27 mg/L, respectively). Without the obvious clinical manifestation of sepsis, the antibiotics meropenem and vancomycin were stopped and the patient was discharged from the hospital (Figure 2). However, the antituberculosis regimen was still going on. One month after the discharge, the patient was in a good state and complained no discomfort. He was retested with the PCT of 2.941 ng/mL and the metagenomic Next-Generation Sequencing of pathogenic microorganisms was negative.