A rare case report of linezolid induced thrombocytopenia

Abstract

Introduction: Oxazolidinone like linezolid are widely used antibiotics because of the growing prevalence of resistant gram-positive infections. Because of its unique mode of action by inhibiting protein synthesis, it is widely effective against various resistant strains like penicillin-resistant and vancomycin-resistant strains of various gram-positive bacteria. It is widely used in the treatment of skin and soft tissue infection including MRSA and MSSA, also used in community-acquired pneumonia, and the combination is used in extensively drug-resistant tuberculosis. The most common side effect of linezolid includes gastrointestinal disturbances like nausea and vomiting. Serious adverse effects include Myelosuppression including thrombocytopenia, anemia, pancytopenia, and leukopenia. Peripheral neuropathy, optic neuritis, and lactic acidosis are also reported.

Case Presentation: Here we report a case of progressive but reversible thrombocytopenia in 75 years old male patient after receiving linezolid therapy for severe sepsis with multi-organ dysfunction with AKI on CKD with hepatic encephalopathy, severe hyponatremia with aspiration pneumonia. On the 9^th day of linezolid, therapy thrombocytopenia was noted and immediately linezolid was stopped. After the 12^th day, his platelet count went up which might be suggestive of linezolid induced thrombocytopenia.

Conclusion: Physicians should be more vigilant in monitoring complete blood count, especially in elderly patients who are receiving linezolid for more than two weeks. They should also make a risk assessment based on creatinine clearance, baseline platelet count, immunosuppression therapy, baseline hemoglobin, and prior/present antibiotics therapy so that adverse reactions can be prevented.