Linezolid and Clofazimine are essential second-line medications used in the treatment of multidrug-resistant tuberculosis (MDR-TB). Both drugs are recognised for their efficacy; however, prolonged therapy is associated with adverse effects, including peripheral neuropathy and anaemia. We report a case of a female patient in her 20s on an oral long-term MDR TB regimen including Linezolid and Clofazimine, who presented with peripheral numbness, fever, and generalised weakness of two weeks’ duration. Investigations revealed bicytopenia with severe normocytic normochromic anaemia and features consistent with drug-induced peripheral neuropathy on nerve conduction velocity studies. Causality assessment using the Naranjo Adverse Drug Reaction Probability Scale indicated a probable causal relationship for both Linezolid and Clofazimine. Both of the drugs were discontinued. One unit of packed red blood cells (PRBC) was transfused for severe anaemia. The patient was initiated on antibiotics, IV fluids, Vitamin B12 supplementation, and other supportive measures, including physiotherapy. The patient showed gradual clinical improvement following drug withdrawal and was discharged in satisfactory condition. This case highlights the importance of awareness & regular monitoring for neurotoxic and hematological adverse effects in patients receiving prolonged MDR-TB therapy and the need for timely drug modification to prevent irreversible harm.

KEYWORDS: MDR TB, Linezolid, Clofazimine, Peripheral Neuropathy.