This study reports the first cases of simultaneous echinococcosis and tuberculosis (TB) in China, identified in two patients from Xiji County, south Ningxia Hui Autonomous Region. Both patients had advanced echinococcosis, which altered their immune profile from a Th1 to Th2 response, as shown by a TB skin test that initially was positive but later became negative. This immune shift is common in chronic helminth infections. The study highlights the challenges in diagnosing TB and echinococcosis in co-infected individuals, which may explain the limited number of global reports of simultaneous infections. The prevalence of TB in Xiji County was higher in areas co-endemic for TB and echinococcosis compared to areas endemic only for TB, suggesting co-infection with Echinococcus may be a contributing factor. The incubation period for echinococcosis is 10-15 years, so primary infections with both TB and Echinococcus likely occurred at the same time. The two patients were diagnosed with advanced stages of both diseases, with effective treatment for echinococcosis but not for TB. Albendazole treatment was effective in the first patient but not in the second. The study suggests that combined TB/echinococcosis surveys should be conducted in this area to improve diagnosis and treatment outcomes, reducing morbidity and mortality. The study also highlights the challenges in diagnosing these diseases in underdeveloped areas with limited resources and expertise. The findings emphasize the need for improved diagnostic methods and treatment strategies for co-infected patients.This study reports the first cases of simultaneous echinococcosis and tuberculosis (TB) in China, identified in two patients from Xiji County, south Ningxia Hui Autonomous Region. Both patients had advanced echinococcosis, which altered their immune profile from a Th1 to Th2 response, as shown by a TB skin test that initially was positive but later became negative. This immune shift is common in chronic helminth infections. The study highlights the challenges in diagnosing TB and echinococcosis in co-infected individuals, which may explain the limited number of global reports of simultaneous infections. The prevalence of TB in Xiji County was higher in areas co-endemic for TB and echinococcosis compared to areas endemic only for TB, suggesting co-infection with Echinococcus may be a contributing factor. The incubation period for echinococcosis is 10-15 years, so primary infections with both TB and Echinococcus likely occurred at the same time. The two patients were diagnosed with advanced stages of both diseases, with effective treatment for echinococcosis but not for TB. Albendazole treatment was effective in the first patient but not in the second. The study suggests that combined TB/echinococcosis surveys should be conducted in this area to improve diagnosis and treatment outcomes, reducing morbidity and mortality. The study also highlights the challenges in diagnosing these diseases in underdeveloped areas with limited resources and expertise. The findings emphasize the need for improved diagnostic methods and treatment strategies for co-infected patients.