Hello.
Thank you for your query at DoctorSpring.com.
I understand your concern and will do my best to help you. A visit to the ER is not required as of now.
I gather your daughter is 18 years old and on treatment for latent TB. Please correct me if I am wrong.
I would require a few more details.
1. Does she have a cough?
2. Is the chest pain diffuse involving the entire chest or is it present only in either the right/ center/ left of the chest?
3. Apart from the shoulders, does she have any other joint pain or swelling?
4. What dose of Vitamin B6 (Pyridoxine) is she on?
5. Does she have any profuse sweating, diarrhea or bladder symptoms now?
Please reply to the above in the follow up.
6. How long has she been on this treatment?
The pain and numbness of hands and feet could be due to peripheral neuropathy due to Isoniazid. Vitamin B6 is given along with it in order to prevent this adverse effect. In case of Isoniazid induced peripheral neuropathy, treatment is with high dose Viatmin B6.
However, the shoulder and chest pain are not due to peripheral neuropathy, and could be part of generalized body ache generally associated with fever and infections.
I would advice that you give her Tylenol 500 mg every 4 hours. This would be safe and good for her pain.
Awaiting your response,
Kind regards.
Patient replied :
Hi. Thanks. She does not have a cough. No signs of active TB. Her chest pain was all over, from shoulders on down (it's gone now, except she still has some pain in her sternum area). Joint pain is pretty much in her limbs, (arms, hands, shins, and feet). And also numbness in limbs. She is on 50mg of b6. She has been on both medications for a month. And no she doesn't have any diarrhea or blader symptoms, or sweating. Just weakness, tired, and this morning she's still numb mainly in her hands and arms. She's very shaky too, and had some muscle twitches last night. I gave her 100mg of b6 yesterday (1 extra). Should we give her more today? Are you aware of other medications she can take for the latent TB? We do see her Dr. on Monday afternoon, but in the meantime this is very helpful.
She also tells me her ankles are swollen.
Hello. Thank you for writing to us again.
I am glad that her chest pain has subsided to an extent.
All the other symptoms i.e weakness, tiredness, muscle twitches, numbness can be attributed to her peripheral neuropathy symptoms. Normally people who get severe peripheral neuropathy, we recommend higher doses for pyridoxine, sometimes even up to 5 mg/ kg. So since she has been having this complication, i will ask you to increase her dose gradually. You can give her 100 mg for the next one week or so, and if the symptoms still persist, i will recommend 150 mg till she is on treatment. For her pain you can give her tylenol for another couple of days till her pain completely subsides.
With proper dose of b6, peripheral neuropathy can be completely prevented. Hence i recommend you increase the dose slowly. For some cases even a daily dose of 50 mg is enough, however she needs higher dose as this point.
Yes there are other medicines like Rifampin, but they cause severe hepatic side effects and hence Isoniazid is preferred.
Feel free to discuss further,
Regards