The fourth case is a 22-year-old HIV-negative female patient diagnosed with MDR-TB and initiated on levofloxacin-bedaquiline-prothionamide-cycloserine-para-aminosalicylic acid and pyrazinamide. After taking the above regimen for a month, the patient presented to the Hospital with 5 days' complaints of vomiting and admitted with diagnosis of Dehydration secondary to fluid loss from vomiting due to gastrointestinal upset and to rule out liver injury. All TB medications were stopped, blood sample drawn for chemistry test and patient was rehydrated. ECG done on the next day showed a sinus rhythm with QTcF of 536 msec. Blood tests revealed only mild elevation of liver enzyme (ALT=68 u/L and AST=Normal) with mild hypokalemia (3.46 meq/l). The ECG abnormality resolved few days later after rehydrating patient, and the same regimen re-started, with no repeat record of prolonged QT over two weeks' period. However, the liver enzymes kept on rising reaching (ALT= 207 u/L and AST=171 u/L). As a result, possible hepatotoxic drugs (i.e. Pyrazinamide, Bedaquiline, and Para-aminosalicylic acid) were permanently stopped. Delamanid was added making a regimen containing Levofloxacin-Prothionamide-cycloserine-Delamanid-Linezolid. The patient took this regimen without any problem for 20 months and finished her treatment with an outcome of cure.