Cycloserine (anti-tuberculous drug) and psychiatric disorders: A case report

Background: Tuberculosis continues to pose a significant global public health challenge, especially with the rise of multidrug-resistant tuberculosis (MDR-TB), necessitating second-line treatment regimens that entail considerable adverse effects. cycloserine, an important second-line anti-tubercular drug, is well-known for its neuropsychiatric side effects, which include depression, anxiety, psychosis, and obsessive-compulsive symptoms.

Case Presentation: We present the case of a 30-year-old male patient with a history of insulin-dependent diabetes mellitus and no previous psychiatric disorders, undergoing treatment for pulmonary tuberculosis. After treatment failure and confirmation of MDR-TB, the patient began a second-line regimen that included cycloserine. After three months of treatment, he started to have depressive symptoms, trouble sleeping, ringing in his ears, headaches, and obsessive-compulsive thoughts that were religious in nature. A psychiatric evaluation resulted in a diagnosis of depressive disorder with obsessive-compulsive characteristics, presumably associated with antitubercular treatment. Fluoxetine and alprazolam were given to treat the symptoms, and this helped a little.

Conclusion: This case underscores the necessity of identifying and swiftly addressing psychiatric adverse effects linked to cycloserine and other second-line antitubercular medications. To make sure that patients with MDR-TB are safe and get the best treatment possible, pulmonologists and psychiatrists need to work closely together.