Thank you for posting this in Microsoft Q&A.
I'm glad that you were able to resolve your issue and thank you for posting your solution so that others experiencing the same thing can easily reference this! Since the Microsoft Q&A community has a policy that "The question author cannot accept their own answer. They can only accept answers by others ", I'll repost your solution in case you'd like to "Accept " the answer.
Issue:
Need to Enable Microsoft Defender Real-Time Protection on Azure VM
Solution:
Issue Fixed by @Cristopher Aguilera
Upon reviewing the configuration, I confirm that Real-Time Protection is already enabled on the VM.
If you have any other questions or are still running into more issues, please let me know. Thank you again for your time and patience throughout this issue.
Please remember to "Accept Answer" if any answer/reply helped, so that others in the community facing similar issues can easily find the solution.