What Causes Raised ESR Count Along With Elevated Liver Enzymes?

Posted on Tue, 3 Feb 2015

Medically reviewed by Ask A Doctor - 24x7 Medical Review Team

Tue, 3 Feb 2015 Answered on

Thu, 19 Feb 2015 Last reviewed on

Question : Hello Dr.,
I have attached 4th X-Chest Ray and LFT and ESR reports. You will find 2 rpeorts for LFT and ESR reports. One is for the date 15-10-2014 and another one on 01-02-2015. Please compare all rpeorts and let me know for further steps to be taken by me.
I have also consulted with my Dr.Danodha and he suggested me to stop all drugs as my TB is controled now.
Till yesterday i was taking R-Cinex 600,300 and BECOSULES. What would you suggest for extra precaution.
Why is my ESR and other factors increaseing (Report attached).Is there any other problem.

Answered by Dr. Drkaushal85 (2 hours later)

Brief Answer:
you are having drug induced hepatitis.

Detailed Answer:
Hello dear, thanks for your question on HCM.
I have gone through all the reports.
Your recent reports (2-2-2015) are suggestive of raised liver enzymes (hepatitis) as compare to previous report.
So possibility of Anti TB drug induced hepatitis is more. Rcinex (Rifampicin and isoniazide) both are hepatotoxic and can cause elevated liver enzymes, due hepatic cellular injury.
And ESR is marker of inflammation. And it is also raised in hepatitis.
So your recent ESR is raised mostly due to anti TB drug induced hepatitis.
Treatment for this is to stop offending drug (anti TB). Start high glucose and high protein diet. Avoid fatty and oily food.
Get done repeat LFTs after 7 days and see for trend (increasing or decreasing).
Also get done ultrasound examination of liver to see for liver parenchyma.
I want to know your weight. Because Rcinex 600-300 is for weight more than 60 KGS. For weight less than 69 kg Rcinex 450-300 is sufficient. So , I need to rule out overdosing of rifampicin in you. As overdosing can cause drug induced hepatitis.
So reply me your weight, so that I can guide you further.
I will be happy to help you better.
Wish you good health.
Thanks.

Above answer was peer-reviewed by : Dr. Bhagyalaxmi Nalaparaju

Follow up: Dr. Drkaushal85 (20 minutes later)

My Weight is 102 KG.
What is my X-Ray Saying? IS TB cured in my case?

Answered by Dr. Drkaushal85 (13 minutes later)

Brief Answer:
No need to worry regarding chest x ray.

Detailed Answer:
Hello dear,

Thanks for your follow up question on HCM.

I have gone through your chest x ray. It is normal. No need to worry for tuberculosis. Your TB is cured. Don't worry about this.

And your dose for Rcinex 600-300 is appropriate for your weight.

What is your height?
Are you obese?

Please reply me these answers, so that I can guide you better.

I will be happy to help you further.
Wish you good health.
Thanks.

Above answer was peer-reviewed by : Dr. Ashwin Bhandari

Follow up: Dr. Drkaushal85 (9 minutes later)

Thanks for the quick answer.
Yes i am obese.
My Weight is 102 KG and my height is 5 feet 11 inch.

Answered by Dr. Drkaushal85 (1 hour later)

Brief Answer:
Lose some weight.

Detailed Answer:
Hello dear,

Thanks for your follow up question.

In my opinion, your weight is more according to your height. So excess body fat can accumulate in you liver and give rise to fatty liver.

This can also cause elevated liver enzymes.

So get done ultrasound examination of liver to rule out this.

It will also tell you about drug induced liver damage is present or not.

So, I advice you to follow strict dieting, exercise and dedicated efforts for weight loss.

Hope I have solved your query.
I will be happy to help you further.
Wish you good health.
Thanks.

Above answer was peer-reviewed by : Dr. Ashwin Bhandari

Follow up: Dr. Drkaushal85 (22 minutes later)

Tell me one thing Dr. that treatment of TB goes on upto 1 year. But my Dr just stopped my drug in 6 months. In future how much chance to have TB again?
To escape form this type of illness what precaution should i follow.
Please suggest some fruites to improve my liver health.

Answered by Dr. Drkaushal85 (16 minutes later)

Brief Answer:
Treatment of TB should be of atleast 6 months.

Detailed Answer:
Hello dear,

Thanks for your follow up question on HCM.

Treatment of tuberculosis should be taken for atleast 6 months. Minimum 6 months treatment is must. Further prolongation of treatment is based on clinical, radiological findings. If patient is improved with 6 months of treatment then no need for further treatment.

If you follow good nutritional diet and maintain your immunity then future chances of tuberculosis are less than 3% in whole life.
So no need to worry much for future tuberculosis.
Take high protein, vitamin rich and anti oxidant rich diet to maintain your immunity.

For liver health, you can take fruits like sugarcane, apple, grapes, banana, papaya, chiku etc.

Hope I have solved your query.

I will be happy to help you further.
Wish you good health.
Thanks.

Above answer was peer-reviewed by : Dr. Ashwin Bhandari