I coughed blood and am being treated for TB. I need expert advise.

Question

Hello doctor,

I was positive for hepatitis B four years ago, and recently I was rushed to the hospital for coughing up blood from my lungs. The CT chest shows that there are some bleeding areas in my lungs. The Gene expert test shows that I have very low tuberculosis. My kidneys are normal and my liver is normal except that the total bilirubin is 32 umol/L and conjugated bilirubin is 10 umol/L. My anti-nuclear factor is positive. I am currently being treated for TB. I need expert advise. I have some test results with me.

Answer 1

Hello,

Welcome to icliniq.com.

As your gene Xpert report (attachment removed to protect patient identity) shows you have been tested positive for MTB which is sensitive to Rifampicin. Means you have pulmonary tuberculosis and it is sensitive to first-line drugs. The standard treatment in this case is combination four drug ATT (antitubercular treatment) for two months followed by further to six months of three drug treatment. And periodic sputum culture and X-ray for response assessment. Next problem is you have hepatitis B. And you have not been on any medication for the same. Your OT/PT is normal. I would like to know your HBV DNA levels and HBeAg status as it will help in determining whether you need treatment for hepatitis B also.

As far as ANA positivity is concerned, it can be associated with hepatitis B also in about 1 to 2 percent population it can be a normal phenomenon. If you do not have symptoms of joint pain, fever photosensitivity then you do not need to worry about ANA reports. Lastly, I would like to knowhow was your bilirubin level before ATT as antitubercular treatment can also affect the liver. So if you are having persistent pain or vomiting you need to stop the drugs and visit your physician, as they might need some modification.

I would be happy to hear from you again.