Linezolid-induced peripheral neuropathy in a patient with multidrug-resistant pulmonary tuberculosis: a case report and comprehensive literature review.

Background: Multidrug-resistant tuberculosis (MDR-TB) remains a major global health challenge due to the limited availability of effective therapeutic options. Among second-line agents, linezolid has demonstrated excellent efficacy in both MDR-TB and extensively drug-resistant tuberculosis (XDR-TB), owing to its high oral bioavailability, good tissue penetration, and low resistance profile. However, its long-term use is frequently limited by adverse effects-most notably peripheral neuropathy, along with optic neuritis and myelosuppression-which often lead to early treatment discontinuation and suboptimal outcomes. Case presentation: We report the case of a 28-year-old man with multidrug-resistant pulmonary tuberculosis who developed progressive, painful distal peripheral neuropathy in the lower limbs with ataxic gait approximately 10-12 weeks after initiating a linezolid-containing second-line antitubercular regimen. Linezolid was discontinued after approximately five months of exposure, with marked clinical improvement on follow-up. Literature review: To contextualize this case, we reviewed 13 studies comprising 88 patients with linezolid-associated neurotoxicity. The most frequently reported symptom was painful distal paresthesia, typically emerging after 2 to 6 months of treatment. Neurophysiological studies, when available, confirmed axonal sensorimotor neuropathies. While most patients showed improvement following drug withdrawal, a notable proportion had persistent neurological deficits. Conclusion: In high-burden settings like India, where MDR-TB is increasingly prevalent, clinicians must maintain a high index of suspicion for linezolid-induced neuropathy. Early identification and timely cessation of the drug are essential to reduce the risk of irreversible neurotoxicity and improve long-term treatment outcomes.