What Causes Elevated ESR Levels While Treating Extra Pulommanary TB?

Posted on Thu, 23 Jun 2016

Question: my mom has extra pulommanary tb and she has taken tb treatmnt for 2 months with 4drugs theraphy
now her esr measures 68. why it so

Answered by Dr. Tushar Kanti Biswas (7 hours later)

Brief Answer:
Extra pulommanary TB and ESR

Detailed Answer:
Hi,

Thank you for your query. I can understand your concerns.

ESR is non-specific phenomenon and not a good guide.

ESR is often high in elderly people (your mom is 75 years old).
ESR increases with age and in both men and women over the age of 60 an ESR of 20 mm/hour or more may be present without any obvious cause .
Anemia itself may cause some increase in ESR.
What is her hemoglobin level(HB%)?
Nevertheless in chronic disease like TB,ESR is often raised.
Please continue anti-tubercular drugs as before .For extra-pulmonary tuberculosis Anti-tubercular treatment may have to taken for 9-12 months.

ESR will eventually return to normal range.

Regards

Dr. T.K. Biswas M.D. XXXXXXX

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Tushar Kanti Biswas (1 hour later)

Her hb is 11% and Doctor has asked her to take Rifa + Iso drug combination (2 drug )

Answered by Dr. Tushar Kanti Biswas (9 hours later)

Brief Answer:
Extra pulommanary TB and ESR

Detailed Answer:
Your mother is having mild anemia (HB-11 G%) and hence it is not contributing to elevated ESR significantly.
High ESR is due to extra-pulmonary TB which requires prolonged anti-tubercular treatment(ATT) and 2 months of ATT is not good enough for ESR to return to normal range.
Other causes of very high ESR is multiple myeloma.It will be worthwhile to do urine screening for Bence-Jones protein.

Dr. T.K. Biswas M.D. XXXXXXX

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Above answer was peer-reviewed by : Dr. Prasad