Linezolid-induced Sideroblastic Anaemia: A Reversible but Overlooked Adverse Effect

Abstract

With the ever-evolving guidelines and changing drug regimens for tuberculosis (TB), it is paramount for treating physicians to understand the efficacy and safety profiles of the drugs being used. Linezolid is included in the treatment of multidrug-resistant (MDR) and extensively drug-resistant (XDR) TB. A 60 year old man with MDR TB was managed with oral AKT (anti-Kochs therapy) drugs including linezolid. Six months after starting the therapy, he presented with complaints of giddiness, dyspnea on exertion and easy fatiguability. Investigations revealed severe anemia, thrombocytopenia, reticulocytopenia, leukopenia, normal liver and renal function. With Linezolid induced pancytopenia being one of the major differentials, AKT containing Linezolid was discontinued immediately. The patient was initiated on appropriate supportive care, including blood transfusions and alternative antibiotic therapy. Over the subsequent weeks, the patient's symptoms improved, and his hemoglobin levels gradually returned to the normal range. Clinicians are habituated to treating Gram-positive infections with short courses of linezolid. This should be avoided especially in a country like India where tuberculosis burden is very high, as linezolid is an essential part of treatment of MDR TB. Regular and planned monitoring for side effects is required when linezolid is used at higher doses and longer durations, such as for the management of Tuberculosis. Further research is warranted to elucidate the pathogenesis of linezolid-induced sideroblastic anemia and identify potential risk factors for its development.