A Two-Front Battle - A Case Report of Pulmonary Tuberculosis and Concurrent Peripheral Neuropathy

Sep 30, 2026

Uploaded by Damian

Peripheral neuropathy is often linked to tuberculosis (TB) treatment, but onset before starting anti-TB therapy is uncommon. The report describes a 27-year-old patient with persistent severe burning pain in both lower limbs, alongside chronic cough, weight loss, and fever. Pulmonary TB was confirmed by sputum analysis, while burning paresthesias prompted investigations that established neuropathy via electrophysiology and tissue biopsy. Other acute neuropathy causes were negative, supporting para-infectious TB neuropathy likely immune-mediated rather than drug-induced. The case underscores the need for careful differentiation to avoid misdiagnosis and enable timely management.

LanguageEnglish

CategoryHealthcare

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Pages6

Reading Time15 min

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Abstract

Introduction

Case Presentation

Review began 11/12/2025 Review ended 12/02/2025 Published 12/08/2025 © Copyright 2025 Mahmoud et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CCBY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited. DOI: 10.7759/cureus.98778 Open Access Case Report A Two-Front Battle: A Case Report of Pulmonary Tuberculosis and Concurrent Peripheral Neuropathy Hazim Mahmoud 1 , Malaz Khalifa 2, Ahmed Ahmed 3, May Jalal 4, Safwan Ahmed 5 1. Internal Medicine, Hamad Medical Corporation, Khartoum, SDN 2. Pathology and Laboratory Medicine, Hamad Medical Corporation, Khartoum, SDN 3. Anesthesia, Hamad Medical Corporation, Khartoum, SDN 4. Radiology, Hamad Medical Corporation, Khartoum, SDN 5. Neurology, Hamad Medical Corporation, Doha, QAT Corresponding author: Malaz Khalifa, [mloooooozaa@gmail.com](mloooooozaa@gmail.com) Abstract Peripheral neuropathy is often observed in patients with tuberculosis (TB), usually as a side effect of treatment rather than a direct result of the infection. Neuropathy presenting prior to the initiation of antiTB therapy is considered uncommon. We describe a 27-year-old patient who presented with persistent, deep burning, severe pain in the bilateral lower limbs against a background of chronic cough, weight loss, and fever. The patient was evaluated for the clinical symptomology and was found to have pulmonary TB based on sputum analysis. Concurrently, evaluation of lower limb burning paresthesias revealed evidence of neuropathy confirmed both electrophysiologically and by tissue biopsy. Evaluations for causes of acute neuropathy were negative, leading to a diagnosis of para-infectious neuropathy related to TB. Neuropathy in TB is most often drug-induced, especially with medications such as isoniazid or linezolid in drug-resistant cases. In this patient, however, symptoms developed before treatment, pointing to a para-infectious mechanism, likely immune-mediated inflammation affecting the peripheral nerves. This case shows a rare but important manifestation of para-infectious TB neuropathy presenting before therapy begins. Recognizing this distinction is crucial to avoid misdiagnosis and ensure timely, appropriate management. Categories: Neurology, Internal Medicine, Infectious Disease Keywords: axonal degeneration, immune-mediated neuropathy, nerve biopsy, para infectious, peripheral neuropathy, pulmonary tuberculosis Introduction Peripheral neuropathy (PN) is a clinical condition characterized by dysfunction of peripheral nerves distal to the nerve roots. It can involve a single nerve (mononeuropathy) or multiple nerves (mononeuropathy multiplex or polyneuropathy) . The most common form is a symmetrical, length-dependent polyneuropathy, typically starting in the distal lower limbs [1] . The most common etiologies include diabetes; nutritional deficiencies such as vitamins B1, B6, and B 12, as well as copper and vitamin E; toxin exposures such as lead and mercury; and immune-mediated neuropathies [2] . Clinical manifestations will depend on whether thereis a predominant motor or sensory affliction. In the context of tuberculosis (TB), neuropathy is commonly seen as a consequence of drug toxicity, most commonly isoniazid [3] . According to a large review, the reported incidence of PN in patients with drug-susceptible TB (DS-TB) ranges from 0% to 10%[4] . In a cohort study from Swaziland involving 250 patients with DS-TB from a single hospital, the overall prevalence was 12% . Rates were higher in males (18%) compared to females (7%) and were most pronounced in adults over 45 years of age, reaching 20%[4] . In patients with drug-resistant TB (DR-TB), the prevalence of PN is significantly higher, with reported figures ranging from 13% to 17%[4] . This increased risk is likely related to the use of more neurotoxic medications and the l

FAQs

Why is peripheral neuropathy before anti-TB therapy considered uncommon?

Peripheral neuropathy in TB is most often attributed to treatment-related drug toxicity. Neuropathy presenting before starting anti-TB therapy is therefore rare.

How was pulmonary tuberculosis confirmed in the case?

Pulmonary TB was confirmed using sputum analysis, including a positive acid-fast bacillus (AFB) smear and positive Mycobacterium tuberculosis (MTB) DNA.

What evidence supported that neuropathy was para-infectious rather than drug-induced?

Symptoms began before treatment, and evaluations for other causes of acute neuropathy were negative. Neuropathy was confirmed electrophysiologically and by tissue biopsy, supporting an immune-mediated para-infectious mechanism.

Sep 30, 2026

Uploaded by Damian