A 40-year-old male from Dilla presented with right side chest pain and cough which is productive of whitish sputum of one-year duration. These symptoms were worsened in the last three months the patient has also night sweating, fever, loss of appetite, and loss of weight but he has no previous history of TB treatment and contact to the TB patient.
CHEST- there is dullness and decreased air entry on the right posterior lower 2/3 of the lung field. CVS- S1 and S2 are well heard.
Abdomen-flat and soft to palpation. CNS-conscious and oriented to time, place, and person (TPP).
The neurologic exam findings before the initiation of treatment were normal.
He was chronically sick-looking. V/S: BP-100/70, PR-120, RR-24, T-37.2C. He has pink conjunctivae and a non-icteric sclera. 
ESR -104mm/hr, WBC =1,346,000, HCT =33%, PLT= 425,000, HIV test =NR. Gene Xpert Mycobacterium tuberculosis was detected with RMP resistance. Chest-X-ray showed right side homogeneous opacity with mass effect, with the index of massive pleural effusion. MDR-TB treatment was started with a short-term regimen (4-6 KM-Mf-Pto-Cfz-Z-HH-E/5Mfx-Cfz-Z-E). Two and half months after the initiation of treatment he developed decreased hearing ability which is bilateral and he had also vertigo. Then the treatment was discontinued for 4 days.
The patient was conscious and oriented to time, place, and person. There is decreased hearing ability bilaterally with sensorineural hearing loss and gait abnormality. The diagnosis of sensorineural hearing loss secondary to drug toxicity (kanamycin) was made and the patient was referred to Yirgalem Hospital for further workup and management.