A Unique Case of Pretonamid Resistance on MDR TB Patient: A Case Report

<i>Background</i>: Pretomanid is a novel medication that belongs to the class of nitroimid-azooxazines. The development of resistance to this novel agent not only complicates clinical management but also poses a threat to public health efforts aimed at controlling TB. This case report highlights the clinical presentation, laboratory findings, and therapeutic implications associated with a patient exhibiting pretonamid resistance. Through this examination, we aim to enhance understanding of resistance mechanisms, underscore the importance of ongoing surveillance, and advocate for refined treatment strategies in the context of MDR-TB management understanding the mechanism of this resistance is crucial for developing effective treatment strategy and improving patient outcome. <i>Case presentation</i>: a sixteen-year-old male patient diagnosed with rifampicin-resistant PTB (RR-PTB) after he presented with a cough of two weeks duration and he is on treatment for RR-PTB, and he is on BpaLM regimen. The third-month second-line phenotypic DST result revealed pretomanid (Pa) resistance. [Stm, INH, RIF, EMB, Pa are resistant, and Bdq, Clf, Dlm, Lfx, Lzd, and Mfx are sensitive]. <i>Clinical Discussion</i>: Following the hospital’s clinical panel team and national TB program expert’s discussion we changed the regimen to individualized (Lfx, Cs, Bdq, Dlm, Cfz and Lzd). <i>Conclusion</i>: Pretomanid resistance in humans reveals a low prevalence but highlight the need for vigilance. And since it’s the incorporated in BPaL regimine and its among the backbone of the regimen we should have to follow the resistance pattern. While facing Pretomanid resistance Consult experts, engage a physician experienced in drug-resistant TB for treatment planning and management, monitor adverse effects closely observe patients for signs of myelosuppression, peripheral neuropathy, and hepatotoxicity during treatment with the BPaL regimen. And also ensure timely susceptibility testing for all components of the BPaL regimen to guide effective treatment adjustments then go for alternative regimen.