Drug-induced Peripheral Neuropathy due to Anti-tubercular Treatment and Superadded Eczema Herpeticum in Miliary Tuberculosis

Abstract Drug-induced peripheral neuropathy (DIPN) is potentially irreversible, resulting in sensory deficits and paresthesia in drug-resistant antitubercular treatment (ATT). A 26-year-old female with miliary and multidrug-resistant tuberculosis presented with severe, sharp, burning pain in bilateral lower limbs with superadded eczema herpeticum. The patient was on the second line of ATT, including linezolid and cycloserine. After a few weeks, the patient developed severe peripheral neuropathy and eczema herpeticum. Linezolid and cycloserine were stopped. The modified treatment included tablet delamanid, tablet pyrazinamide, tablet clofazimine, levoflox, pyridoxine, and tablet levetiracetam. Tablet acyclovir and local fucidin cream were started for eczema herpeticum. In pain clinic, treatment included local management of lesions and medications for neuropathic pain. This resulted in reduction of Visual Analog Scale from 10/10 to 1–2/10 over a period of 6 months to 1 year during follow-up. DIPN warrants the early identification of the offending drug, discontinuation, and institution of alternate ATT drugs for preventing irreversible damage.