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How to treat exrapulmonary lymphatic TB when allergic to ATT?

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Posted on Thu, 24 Jul 2014
Question: How to treat exrapulmonary lymphatic TB when allergic to ATT?
I have been diagnosed with extrapulmonary lymphatic TB. The mass is mediastinal. I have been suggested to use, Rifampicin 600 mg, pyrizinamide 1050 mg, ethambutol 800 mg and Isoniazid 300 mg. When I used the above drugs, I had developed fever, body pain, throat soreness, boil in the mouth and severe itching all over legs and hands. My physician had advised me to stop ATT and restart the medications with lower doses. Please advice on how to go ahead with the treatment as I am worried that dicontinuation of the medication will result in development of resistence to the treatment. plesae also suggest what other medications can be used to treat TB?
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Answered by Dr. Gyanshankar Mishra (50 minutes later)
Brief Answer:
ATT challenge is required.

Detailed Answer:
Hi,
Thanks for posting the query on HCM. After going through your query, I would like to comment the following:

1. You seem to have been started on ATT for mediastinal adenopathy.

2. Considering your reaction to ATT in the said doses, a ATT rechallenge is required to pick up any specific ATT drug which could be causing such reactiion inspite of antihistamine medication (eg. cetrizine).

3. You need to visit a Pulmonologist an the ATT rechallenge can be done starting with lower doses and increasing to normal doses and then it can be found as to the specific drug causing the reaction, which can then be treated accordingly.

I hope I have answered your query. I will be glad to answer follow up queries if any. Please accept my answer if you have no follow up queries.

Regards
Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist
Above answer was peer-reviewed by : Dr. Prasad
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Follow up: Dr. Gyanshankar Mishra (19 hours later)
1.     I doubt that my allergic reactions are for Isoniazid or Rifampicin. Will affective treatment is possible without using the allergic and using all others??
2.     I have also told by another physician that if values are not abnormal in the immunoglobulin assay, the treatment is not required. How true is that??
3.      I was hospitalized after using ATT for 10 days or so after my bronchoscopic biopsy. The reason for hospitalization were bodyahes, fever, severe nausea and vomiting and abdominal pain. The reports showed abnormal AST, ALT and GGTP values. The ultrasound scan of the abdomen showed fat infiltration/hemangioma in the caudate lobe. I was given IV infusions for 4 days and I was discharged. Now it has been some 20 days, I have been discharged and all my LFT are normal, but I still have mild nausea all day long. What could be the reason for this?? Is hemangioma and abnormal LFT related?
4.     I have also heard that people with hemangiomas should not take steroidal drugs. How true is that?? Is there any treatment for hemangioma
5.     What should be done if the LFT become abnormal after usage of ATT for a while as dscontinuation would result in resistence??
doctor
Answered by Dr. Gyanshankar Mishra (3 hours later)
Brief Answer:
Diagnosis of TB should first be confirmed.

Detailed Answer:
Hi,
Thanks for posting the follow up query on HCM.After going through your query, I would like to comment the following:

1. A rechallenge with ATT will only reveal if the reactions are related to ATT or not.

2. Prior to starting ATT, it is presumed that the TB diagnosis is confirmed. A CT guided FNAC/ bronshoscopic FNAC may help in confirmation of diagnosis. Immunoglobulin assay may not be relied upon to stop ATT. Ony if another diagnosis is confirmed, can the att be stopped.

3. Drug induced hepatitis requires hepatosafe att / witholding regular att.

4. Hemangiomas are most of the times incidental findings unless they hamper your liver functions. More than hemangiomas, it is the liver functions that are important.

5. If liver function continue getting abnormal then hepatosafe regime can be taken under medical supervision for 6 to 9 months.

I hope I have answered your query. I will be glad to answer follow up queries if any. Please accept my answer if you have no follow up queries.

Regards
Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Gyanshankar Mishra

Pulmonologist

Practicing since :2003

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How to treat exrapulmonary lymphatic TB when allergic to ATT?

Brief Answer: ATT challenge is required. Detailed Answer: Hi, Thanks for posting the query on HCM. After going through your query, I would like to comment the following: 1. You seem to have been started on ATT for mediastinal adenopathy. 2. Considering your reaction to ATT in the said doses, a ATT rechallenge is required to pick up any specific ATT drug which could be causing such reactiion inspite of antihistamine medication (eg. cetrizine). 3. You need to visit a Pulmonologist an the ATT rechallenge can be done starting with lower doses and increasing to normal doses and then it can be found as to the specific drug causing the reaction, which can then be treated accordingly. I hope I have answered your query. I will be glad to answer follow up queries if any. Please accept my answer if you have no follow up queries. Regards Dr. Gyanshankar Mishra MBBS MD DNB Consultant Pulmonologist