A-14 years-old-girl presented with severe weight loss (severe malnutrition), with chief complaint of fever since 1 month and hemoptysis since 2 days prior. Her parents showed negative for TB screening. History of tuberculosis contact is her neighbour identified MDR-TB and received treatment in our hospital. Her X-pert MTB/RIF revealed positive Mycobacterium tuberculosis with Rifampicin resistant. Culture M. tuberculosis was positive, confirming M. tuberculosis resistant to isoniazid and rifampicin on line-probe assay as well as resistant to second-line injectable agents with second-line LPA, but susceptible to the fluoroquinolones. The chest x-ray showed active tuberculosis with opacity at the right hilar, lobulated infiltrate in the left apex, nodular at left hilar, and enlarged bilateral peri-hilar lymph nodes (Fig. 2). Before starting the therapy she was consulted to the Psychiatry, Ophthalmology and Ear, Nose and Throat department. Baseline electrocardiography (ECG) showed normal QT interval. HIV screening was negative. She started on individualized drugs regimen for pre-XDR TB with levofloxacin (10 mg/kg/day once daily), ethionamide (15 mg/kg/day once daily), cycloserine (10 mg/kg/day once daily), pyrazinamide (35 mg/kg/day once daily), para-aminosalicylic acid (PAS 200 mg/kg/day divided in two dose), bedaquiline (200 mg once daily for 2 weeks). On the second day receiving bedaquiline, the ECG showed prolonged QT interval >500 ms without any electrolyte imbalance, so bedaquiline was stopped and ECG was examined every day. She started to receive linezolid 400 mg per day (10 mg/kg/day once daily) replacing bedaquiline. There was no more prolonged QT after given linezolid. Laboratory examination and clinical manifestation was monitored due to the side effects of the therapy. During hospitalization no other adverse reaction occurred. The laboratory examination is within normal limit. After two weeks hospitalized, she was discharged. She was followed every one month, no adverse reaction of nausea, vomit, jaundice was reported. Linezolid toxicity was also observed during treatment, hematologic value was normal, no anemia nor thrombocytopenia was found, there were no vision loss and color vision test result was normal (evaluated through Ishihara test). No peripheral neuropathy signs (paresthesia, numbness in extremities) were reported. Her weight increased 2 kg after 3 months treatment and her nutritional status improved to normal weight from severe malnutrition after 20 months of treatment. The M.tuberculosis culture result was negative on the first and third month of treatment.