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Is The Treatment Taken For Lymph Node TB Correct?

Posted on Mon, 3 Aug 2015

Question: Hi Doctor,

I am again asking a few questions to you as I am getting puzzled with my mother.

Some important points:-
1) All TB drugs have been discontinued
2) FNAC Test not done(physical examination did ot detect any inflammation of Lymph nodes)
3) Lumbar puncture test not required as said by XXXXXXX Medicine Specialist(cannot do on our own as you can understand)
4) My mother very dedicatedly followed the drug regime only under proper guidance of the Medicine specialist.
5) Some drugs were forced to be discontinued such as:- Pyrazinamide(within 2 months), Isoniazid and Ethambutol(4.5 months), Ofloaxacin(after 7 months) of TB detection
6) She never skipped a single dose or stop all medicines completely
7) She was diagnosed with both Lymph Node TB and TB Meningistis last June(2014).

Please recommend what to do. One of my colleague's brother is a Medicine Specialist who has advised my mother to continue drugs for 6 months more. What exactly can we do?

She has completed Rifamcin(11 months) and Levofloaxcin(5 months).

Thanks and Regards,
XXXX XXXXXXX

Answered by Dr. Anshul Varshney (26 minutes later)

Brief Answer:
Give ms few details.

Detailed Answer:
Hi.
Welcome back. I would be glad to answer your all queries. But just provide me a few details.
1. How is she now? Any fever or any other symptoms?
2. Total duration of Anti tuberclar drugs given?
3. Any medicines she is taking at present?
4. Tuberculosis of which parts of the body was diagnosed? Lungs ? lymph nodes ? Meningeal?
Answer these questions and preferably in point wise manner just to Avoid any communication error.
Revert with the asked details for a better help.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Anshul Varshney (9 hours later)

Hi Doctor,

1) She is perfectly fine now. No symptoms.
2) Total duration-12 months.
3) No TB drugs she is taking. Only regular medicines for diabetes and hypertension.
4) TB was detected in Lymphnodes(left) and Meninges.

Thanks and Regards,
XXXX XXXXXXX
Hi Doctor,

Sorry for missing some important points:-

The Medicine Specialist has asked my mother to do a blood test

The report:-
Basophil-4(Normal is said as 3 or below)
ESR-27(Normal 20 and below)
Lymphocyte:- 44%
WBC-6800(normal below 11000)

others tests are normal-LFT, sugar level, etc.

Thanks and Regards,
XXXX

Answered by Dr. Anshul Varshney (2 hours later)

Brief Answer:
No treatment required now

Detailed Answer:
Dear XXXX,
No treatment is indicated now. We usually treat TB Lymphadenitis and Meningitis for 9-12 months. Since she has completed the course, no medication is indicated now.
These test reports don't signify the presence or absence of tuberculosis in the body. They are normal.
Nothing to be done.
If you have any further query, please ask me.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Anshul Varshney (7 minutes later)

Hi Doctor,

Thanks for your reply. It really freed me of tension.

One thing I just want to ask.

She is suffering from Frozen shoulder(confirmed by both orthopedic surgeon and Medicine specialist) for last one month when she was taking both Levofloxacin and Rifamcin.
1) Is this anything to do with Levofloxacin side effects or TB?
2) I have heard of Glenohumeral joint tuberculosis. Is this any symptoms of it?

Thanks and Regards,
XXXX XXXXXXX

Answered by Dr. Anshul Varshney (5 minutes later)

Brief Answer:
Levoflox can cause

Detailed Answer:
Hello, Yes Levofloxacin can cause such kind of bone pains and joint problems as a side effect.
It would be difficult to comment without an examination of the joint that it's Glenohumeral Tuberculosis or not, but it is very unlikely to be that as she was already on anti tubercular drugs.
You should get her a MRI Shoulder that would reveal the cause.
If it is Frozen shoulder she should be treated with Physiotherapy and Local Diclofenac containing gel.
I hope it helps.
Good Luck.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Anshul Varshney (6 minutes later)

HI Doctor,

She had TB Lymphadenitis on that hand only. But the Medicine specilaist has checked thoroughly(clinical examination) and told us that it was just a Frozen shoulder.

Thanks and Regards,
XXXX XXXXXXX

Answered by Dr. Anshul Varshney (2 minutes later)

Brief Answer:
Get Physiotherapy

Detailed Answer:
See, there is no specific relation with the tuberculosis of the joint and the side on which lymph nodes are.
Moreover , she has been on ATT so, it is very unlikely that she would develop Tuberculosis of the joint.
Get her Physiotherapy and if she doesn't improve get a MRI Shoulder done.
Good Luck.

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar