Cycloserine-Induced Psychosis in Multidrug-Resistant Tuberculosis (MDR-TB) in Young Male Patient: A Case Report

The genre of tuberculosis (TB) dubbed multidrug-resistant tuberculosis (MDR-TB) is resistant to at least two of the most potent first-line anti-TB medications, isoniazid (H) and rifampicin (R). Cycloserine is placed by the World Health Organization as a group four second line anti-tubercular medication for the treatment of MDR-TB. Psychosis, depression, and neuropathy have been linked to neuropsychiatric toxicity, which is caused by cycloserine or its structural equivalent terizidone. After receiving an MDR-TB diagnosis, a 32-year-old male patient received customized treatment regimens including bedaquiline, linezolid, levofloxacin, and Cs. The patient experienced psychosis with agitated behaviour, excessive talking, yelling episodes, fearfulness, photophobia, drowsiness, paranoid thoughts, and headaches multiple times after taking anti-TB medications for 54 days. He was prescribed clonazepam, olanzapine, and lorazepam. Over time, the patient recovered progressively. When giving cycloserine, extreme caution should be used along with frequent and close monitoring, as mental adverse medication reactions may increase the risk of poor drug adherence in patients with drug-resistant tuberculosis.