Cycloserine-Induced Insomnia and Psychosis in Multidrug-Resistant Pulmonary Tuberculosis - A Case Report

Tuberculosis (TB) is a highly infectious disease due to Mycobacterium tuberculosis. The disease presents as drug-sensitive or drug-resistant TB (DR-TB). DR-TB could be of various types like isoniazid mono-resistant, multidrug-resistant tuberculosis (MDR-TB), MDR-rifampicin mono-resistant (MDR-RR), extensively drug-resistant TB (XDR-TB), or pre-extensively drug-resistant TB (pre-XDR-TB). Management of DR-TB is challenging mainly due to longer treatment duration, high pill burden, and adverse drug reactions (ADR) to the second-line anti-TB drugs. Some of these could be life-threatening and require immediate care. Herein, a case of ADR caused by cycloserine in a pulmonary MDR-TB case is presented. All the antitubercular drugs were put on hold, and the symptoms disappeared, only to reappear with the rechallenge of cycloserine. It is emphasized here that a high degree of suspicion with immediate management is imperative to avoid fatal outcomes.