Extensively Drug-Resistant Tuberculosis With Treatment-Limiting Mood Disorder: A Case of Complex Regimen Selection and Mental Health Challenges

Extensively drug-resistant tuberculosis (XDR-TB) presents a significant therapeutic challenge due to resistance to both first-line and several second-line anti-tuberculosis drugs. Treatment planning becomes even more complex when psychiatric comorbidities and drug hypersensitivities further limit the therapeutic arsenal. This case describes a 41-year-old man with a history of prior incarceration and incompletely treated multidrug-resistant tuberculosis, who presented with pulmonary symptoms and was subsequently diagnosed with XDR-TB. Drug susceptibility testing revealed extensive resistance, including to bedaquiline, clofazimine, and moxifloxacin. A pre-existing mood disorder necessitated the avoidance of neurotoxic agents such as cycloserine, and allergic reactions to several antibiotics led to further regimen modifications. This case underscores the clinical difficulty of managing XDR-TB in the setting of psychiatric illness and drug intolerance. A multidisciplinary, individualized approach was crucial in designing a regimen that strikes a balance between antimicrobial effectiveness and mental health considerations. The patient demonstrated early clinical improvement and was discharged in stable condition with continued outpatient follow-up.