A 51-year-old man, with body weight 69 kg was diagnosed as having MDR-TB and was treated with linezolid-containing regimen (cycloserine 750 mg, levofloxacin 750 mg, clofazimine 100 mg, linezolid 600 mg (8 mg/kg body weight), bedaquiline 200 mg). He had diabetes mellitus, chronic kidney disease, and mass in urinary bladder. His blood sugar level was controlled by diet, he had not taken any other medication. Before starting TB treatment, his Hb level was 13 g/dL, neutrophil and platelet count was 7690 /ml and 490,000/ml, respectively. He developed moderate anemia (Hb level 9.6 g/dL) at 4th week of treatment with neutrophil 6560 /ml and platelet 543,000/ml. There was no other cause of anemia found. He was hospitalized and received 2 packed red cell transfusion. Linezolid was continued. Four week later, his Hb level was 11.4 gr/dL, neutrophil 7390 /ml and platelet 434,000/ml. GDF-15 level was markedly high at baseline: 12,105.28 pg/ml (normal 200-1200 pg/ml) and further increased to 27,450.88 pg/ml at the 2nd week of linezolid treatment.
Hematology parameters over time after starting MDR-TB treatment in all three patients are depicted in Fig. 1.