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

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 anti-TB 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.