Contezolid in the Treatment of Multidrug-Resistant Tuberculous Meningitis: A Case Report

Multidrug-resistant tuberculous meningitis (MDR-TBM) has a high mortality rate, and treatment options are limited. Linezolid is recommended for refractory cases but often causes intolerable adverse reactions such as peripheral neuropathy. Contezolid, a novel oxazolidinone, has shown better safety profiles in preclinical and early clinical studies. Here we report a 33-year-old male with MDR-TBM who developed progressive peripheral neuropathy after 6 months of a linezolid-containing regimen. Linezolid was discontinued, but cerebrospinal fluid (CSF) parameters remained abnormal. Contezolid was initiated in July 2023. Within 3 months, the patient's headache and blurred vision resolved; after 5 months of treatment, CSF pressure normalized, protein decreased from 1570 to 501 mg/L, and glucose returned to normal range. No adverse reactions occurred during contezolid therapy, and clinical improvement was sustained through 24-month follow-up. This case suggests contezolid may be a safe and effective alternative to linezolid for MDR-TBM patients with drug intolerance.