Ethambutol-associated mania: A rare case report

Ethambutol is the primary commonly used antitubercular drug for the treatment of tuberculosis and atypical mycobacterial infection. Central nervous system toxicity other than optic neuropathy is not widely reported. We describe a case of a 46-year-old female with abdominal tuberculosis who developed mania after the commencement of ethambutol, and symptoms fully resolved with its cessation. She was prescribed rifampicin, pyrazinamide, isoniazid, and ofloxacin and has no further manic symptoms. This case supports that the patients being treated with ethambutol can develop mania which improves quickly within days of stopping it. A trial of antimanic drugs is needed for short-term rapid improvement of manic symptoms, whereas other anti-tubercular medications can be continued safely.