Grade III Severe QT Prolongation in an Indian Male on All-Oral Longer Regimen for Multidrug-Resistant Pulmonary Tuberculosis: World’s First Case

Antitubercular drugs are associated with several adverse drug reactions (ADRs). Some of these ADRs are life-threatening and require immediate attention and hospital admission. With the development of new regimens and inclusions of newer drugs such as bedaquiline, pretomanid, and delamanid, it is imperative to have an eye for the side effects. A number of antitubercular drugs such as bedaquiline, moxifloxacin, clofazimine, pretomanid, and delamanid are known to cause ADRs on the heart. Herein, a case of grade III severe QT prolongation with corrected QT (QTc) of 688 ms in an Indian male on a WHO-recommended all-oral longer regimen (AOLR) for multidrug-resistant (MDR) pulmonary tuberculosis (TB) is presented. This episode happened on the sixth day post his treatment initiation, thereby making it the earliest of such findings. The patient was managed conservatively, and his baseline electrocardiogram (ECG) returned to normal with QTc of 432 ms with the offending drug as moxifloxacin, which was omitted from the regimen and replaced with delamanid. There are some cases similar to this case available in the literature; however, grade III severe QT prolongation with QTc of 688 ms in a male on a WHO-recommended all-oral longer regimen for multidrug-resistant pulmonary tuberculosis is never reported.