Linezolid-Induced Pure Red Cell Aplasia: A Case Report

Abstract

Linezolid (LZD) has been widely used for treating the infections of multidrug-resistant gram-positive organisms. As we know, anemias induced by Linezolid (LZD) are common. However, LZD-induced pure red cell aplasia (PRCA) is very rare. In this paper, we report on a 68-year-old woman with intravascular stent infection who developed PRCA after treatment with LZD. The patient presented to our hospital with a 6-month history of fever after stent implantation for aneurysms in both lower limbs. Bone culture grew methicillin-resistant Staphylococcus hemolyticus (MRSH). She received LZD after developing adverse reactions to initial antibiotics. Although her infective symptoms were improved by LZD, progressive thrombocytopenia was observed 23 days after LZD therapy. Her platelets declined to 66*10 9 /L and hemoglobin level was 10.1 g/dL. Thrombocytopenia recovered 12 days after cessation of LZD. LZD was administered again due to recovered fever. 57 days after LZD administration, her hemoglobin level was 4.1 g/dL and reticulocytes were 0.2%. Bone marrow smear revealed active granulocyte proliferation and markedly decreased erythropoiesis with vacuolar degeneration. 12 days after cessation of LZD, her hemoglobin and reticulocyte levels rose to 9.6 g/dL and 5.1%, respectively. LZD was used for the third time as fever and inflammatory markers progressively increased, but Hb was reduced to 6.7g/dL 15 days after LZD therapy . 12 days after cessation of LZD, the hemoglobin level rose to 11.9 g/dL. In summary, we suggest complete blood count and reticulocyte count should be monitored to detect bone marrow suppression during long-term LZD therapy, especially in patients aged over 58 and/or with pre-existing anemia, chronic infections, and renal insufficiency.

Adverse drug events associated with linezolid administration: a real-world pharmacovigilance study from 2004 to 2023 using the FAERS database

“…This could be related to the other side effects of linezolid found in our data, such as thrombocytopenia, a hypocoagulable state, and low fibrinogen levels. Cases of aplasia pure red cell caused by linezolid have been reported (Monson et al, 2002;Waki et al, 2012;Yang et al, 2022), which is consistent with our results. In summary, in addition to hemoglobin and platelet count, coagulation and reticulocyte count must also be considered.…”

Linezolid induced hypoglycemia and anemia: A case report

“…In this study, our patient developed hemoglobin and erythrocytopenia. Nine cases [17][18][19][20][21][22][23] had previously reported that LZD induced anemia in linezolid, and the study found that anemia was reversible after drug discontinuation. It may be because LZD relieves the inhibition of mitochondrial protein synthesis.…”

“…This indicates that the anemia caused by LZD is time‐dependent and dose‐dependent, which may be the result of a gradual increase in plasma concentrations in the later stages of treatment. In addition, for the treatment of anemia caused by LZD, relevant studies have shown 21 , 23 that supplementation of iron, vitamins, folic acid, and EPO cannot prevent and delay the occurrence of anemia, so regular monitoring of related anemia indicators appears to be more important.…”