Cycloserine-Induced Psychosis: A Case Report

Area of Science:

• Pulmonology
• Infectious Diseases
• Psychiatry

Background:

• Tuberculosis (TB) is a significant global health issue caused by Mycobacterium tuberculosis, presenting as drug-sensitive or drug-resistant TB (DR-TB).
• Managing DR-TB is complex due to extended treatment durations and potential for severe adverse drug reactions (ADRs) from second-line anti-TB medications.
• Neuropsychiatric ADRs, particularly those linked to cycloserine, pose a risk for treatment failure and require careful monitoring.

Observation:

• This case report details a patient with pulmonary multidrug-resistant tuberculosis (MDR-TB) who experienced psychiatric ADRs.
• The adverse events were associated with cycloserine, administered as part of a modified, longer treatment regimen.
• Psychiatric symptoms were rigorously assessed using the Brief Psychiatric Rating Scale (BPRS) and Naranjo ADR Probability Scale.

Findings:

• The case highlights significant psychiatric adverse drug reactions (ADRs) linked to cycloserine in a pulmonary multidrug-resistant tuberculosis (MDR-TB) patient.
• These neuropsychiatric events were found to be reversible upon discontinuation of the causative antitubercular agent.
• Diagnostic tools confirmed the severity of psychosis and the likelihood of the ADR.

Implications:

• Emphasizes the critical need for heightened clinical awareness regarding psychiatric ADRs associated with antitubercular drugs, especially cycloserine.
• Underscores the importance of vigilant monitoring and prompt management of neuropsychiatric ADRs to prevent potentially fatal outcomes.
• Demonstrates that timely intervention, including drug withdrawal, can lead to the reversal of severe psychiatric adverse events in DR-TB management.