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Summary: This study describes the first case of extensively drug-resistant tuberculosis (XDR-TB) in the Thames Valley and South East Region and discuss the public health implications, highlighting the need to integrate current epidemiological knowledge with clinical expertise in order to diagnose drug-resistant tuberculosis (TB) early.The management of the XDR-TB patients is challenging with few treatment options, expensive therapy, side effects of drugs and a longer course of the treatment. Keywords: Extensively drug-resistant tuberculosis, Public health