A 66-year-old man, with body weight 40 kg was started on treatment for MDR-TB with the WHO recommended initial regimen (cycloserine 750 mg, levofloxacin 750 mg, clofazimine 100 mg, linezolid 450 mg (11 mg/kg body weight), bedaquiline 200 mg). He had diabetes mellitus treated with insulin. He had not taken any other medication. Before starting TB treatment, he already had low hemoglobin level (10 g/dL), normal neutrophil (6190/ml) and platelet (447,000/ml) count. He developed severe anemia (Hb level 5.7 g/dL) at the 8th week of treatment with neutrophil 1980/ml and platelet 241,000/ml. No other causes of anemia were found. He was hospitalized and received 3 packed red cell transfusion. Linezolid was stopped and changed with delamanid 100 mg bid. Four weeks after linezolid was stopped, his Hb level was 8.8 gr/dL, neutrophil and platelet count were 3030 /ml and 147,000/ml, respectively. Elevated GDF-15 level was detected before treatment: 11,634.4 pg/ml (normal 200-1200 pg/ml).