IntroductionMethadone, a synthetic opioid agonist, has been widely used for the treatment of opioid dependence and chronic pain management for several decades (1). Methadone maintenance treatment (MMT) has proven to be an effective strategy in reducing illicit opioid use, improving patient outcomes, and decreasing the risk of HIV transmission among individuals with opioid use disorders (2). However, despite its therapeutic benefits, methadone can cause significant adverse effects, particularly in opioid-naive individuals or those who consume it recreationally (3).Methadone overdose can lead to severe respiratory depression, cardiac arrhythmias, and death (4). The risk of overdose is particularly high in individuals who are not tolerant to opioids, as they may be more sensitive to the drug’s effects (5). In addition to its well-known respiratory and cardiovascular side effects, methadone can also cause rare neurological and ocular manifestations, such as strabismus (6).Strabismus, a misalignment of the eyes, can occur due to various etiologies, including congenital factors, nerve palsies, and pharmacological agents (7). Opioid-induced strabismus is an uncommon but documented consequence of opioid toxicity, with most cases reported in the context of heroin use (8). The exact mechanism underlying opioid-induced strabismus remains unclear, but it is thought to involve the drug’s effects on the central nervous system and the oculomotor nerve (9).In this case report, we present a rare instance of methadone-induced loss of consciousness and subsequent strabismus in a patient who consumed methadone for the first time. This case underscores the importance of recognizing the potential dangers associated with methadone use, especially in opioid-naive individuals, and the need for healthcare providers to be aware of the uncommon ocular manifestations of opioid toxicity. Prompt identification and appropriate management of methadone overdose and its associated complications can prevent long-term morbidity and mortality (10).

IntroductionTuberculosis (TB), which is caused by bacteria of the Mycobacterium tuberculosis complex, is one of the oldest diseases known to affect humans and a leading cause of death worldwide (1).Approximately one-third of the global population is infected with a lifetime risk of 10% for developing tuberculosis (TB) disease. In 2017, there were 10.4 million reported cases of TB worldwide, corresponding to an incidence rate of 133 cases per 100,000 individuals. Among these cases, 90% were adults over the age of 15, and 64% were male. (2).Iran is considered a high-burden country for tuberculosis, with a notable incidence rate. The endemicity of TB in this region increases the pretest probability of the disease in patients presenting with compatible symptoms and radiological findings (3). Pulmonary TB is usually a disease having a gradual onset. Fever is the most common observed constitutional symptom which characteristically develops in the late afternoon. There may be other manifestations in up to 75% of cases of pulmonary TB, such as malaise, weakness, unusual fatigue, headache, night sweats and weight loss. This is usually accompanied by caseous necrosis and concomitant caseous liquefaction and cough and purulent sputum which is often associated with mild hemoptysis (4).Sputum smear microscopy and culture are commonly used for the diagnosis of pulmonary TB. However, it’s essential to recognize the limitations of these tests (5, 6). Smear microscopy has a sensitivity ranging from 36.9% to 55.6% and specificity of around 99%, while culture has higher sensitivity (approximately 80-90%) but takes longer for results (7, 8). Importantly, negative smear and culture results do not exclude the diagnosis of TB, especially in cases of paucibacillary disease or extrapulmonary involvement (8).