Linezolid induced lactic acidosis and hepatic failure

Abstract

To the Editors, Linezolid is oxazolidinone antibiotic, widely used to treat infections from multidrug­resistant gram positive microorganisms by compromising bacterial ribosome function [1]. Gastrointestinal disturbances, myelosuppression, serotonin syndrome, optic neuropathy and lactic acidosis comprise the constellation of the well known linezolid associated adverse effects [2, 3]. Given the similarities between bacterial and mitochondrial ribosome, this linezolid­ induced lactic acidosis is well expected [4]. This potentially serious side effect occurred mainly during long­term treatment, as depicted from the maximum four­week treatment FDA approval. We describe a patient who developed lactic acidosis and hepatic failure during a few days period of linezolid administration. A 70­year­old female was admitted to the hospital due to fever and hypotension. The patient had a past history of hypertension and osteoarthritis. On evaluation she appeared tired and restless. The blood pressure was 90/65 mmHg, pulse 124 beats per minute, temperature 37.9°C, respiratory rate 28 breaths per minute and Glasgow coma scale 15/15. The abdomen was distended with normal bowel sounds, cardiac sounds and lungs were clear and all other examinations were normal. Chest X­ray was also normal and computed tomography (CT) scan of the abdomen was LETTER TO EDITORS OPEN ACCESS