Linezolid-induced pure red cell aplasia: a case report and literature review

Luo, Zhuanbo; Xu, Ning; Wang, Yun; Huang, Xiaoping; Cao, Chao; Chen, Lei

doi:10.1177/0300060518800126

Cited by 10 publications

(8 citation statements)

References 21 publications

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“…8 But reports about pure red cell aplastic anemia (PRCA) induced by LZD are rare: To our knowledge, only 8 reports have documented about LZD-induced PRCA. 4,[9][10][11][12][13] We reported herein a case of reversible PRCA that developed in a patient who had received 8 weeks of linezolid (600mg twice daily) therapy.…”

Section: Introductionmentioning

confidence: 99%

Linezolid-Induced Pure Red Cell Aplasia: A Case Report

Yang¹,

Chen²,

Gu³

et al. 2022

IDR

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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.

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Section: Introductionmentioning

confidence: 99%

Linezolid-Induced Pure Red Cell Aplasia: A Case Report

Yang¹,

Chen²,

Gu³

et al. 2022

IDR

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“…Study design References Hemoglobin pre-treatment <10.5 g/dL Case control Senneville et al 54 Case report and literature review Luo et al 47 Platelet count Baseline platelet count <173,000/mm 3 Clinical trial Gerson et al 41 Baseline platelet count <240,700/mm 3 Prospective observational Grau et al 55 Baseline platelet count <90,000/mm Combination therapy Caspofungin and levofloxacin therapy Retrospective Chen et al 58…”

Section: Risk Factorsmentioning

confidence: 99%

“…Suppression of mitochondrial respiration via inhibition of mitochondrial protein synthesis is likely the mechanism. Pure red cell aplasia has also been reported as one mechanism of linezolid-induced anemia [ 35 , 46 ].…”

Section: Hematologic Toxicitymentioning

confidence: 99%

Concise Clinical Review of Hematologic Toxicity of Linezolid in Multidrug-Resistant and Extensively Drug-Resistant Tuberculosis: Role of Mitochondria

et al. 2022

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Multidrug-resistant tuberculosis (MDR-TB) is resistant to both rifampicin and isoniazid.Extensively drug-resistant TB (XDR-TB) is a rare type of MDR-TB which is resistant to quinolone and one of the group A TB drugs, i.e., linezolid or bedaquiline. In 2018, the World Health Organization revised the groupings of TB medicines and reclassified linezolid as a group A drug for the treatment of MDR-TB. Linezolid is a synthetic antimicrobial agent in the oxazolidinone class. Although linezolid has good efficacy, it can cause substantial adverse events, especially hematologic toxicity. In both TB infection and linezolid mechanism of action, mitochondrial dysfunction plays an important role. In this concise review, linezolid characteristics as an antiTB drug are summarized, including its efficacy; pathogenesis of 4 hematologic toxicity, highlighting mitochondrial dysfunction; and the monitoring and management of hematologic toxicity.

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“…Myelosuppression is the most common side effect of oxazolidinone antibiotics 105 . They have an inhibitory effect on mammalian mitochondrial ribosomes, especially in the presence of mitochondrial 16S rRNA with A2706G, T3197C, and A3010G gene mutations, which leads to a series of adverse hematological reactions such as aplastic anemia with platelet, red blood cell, and white blood cell reduction 105,106 . Lactic acidosis is another typical side effect of oxazolidinones, caused by low selectivity on bacteria ribosomes.…”

Section: Challenges and Advances In Ribosomal Antibiotics And Bacterial Ribosomesmentioning

confidence: 99%

Ribosome‐targeting antibacterial agents: Advances, challenges, and opportunities

Zhang

Bai

et al. 2021

Medicinal Research Reviews

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Ribosomes, which synthesize proteins, are critical organelles for the survival and growth of bacteria. About 60% of approved antibiotics discovered so far combat pathogenic bacteria by targeting ribosomes. However, several issues, such as drug resistance and toxicity, have impeded the clinical use of ribosome‐targeting antibiotics. Moreover, the complexity of the bacteria ribosome structure has retarded the discovery of new ribosome‐targeting agents that are considered as the key to the drug‐resistance and toxicity. To deal with these challenges, efforts such as medicinal chemistry optimization, combination treatment, and new drug delivery system have been developed. But not enough, the development of structural biology and new screening methods bring powerful tools, such as cryo‐electron microscopy technology, advanced computer‐aided drug design, and cell‐free in vitro transcription/translation systems, for the discovery of novel ribosome‐targeting antibiotics. Thus, in this paper, we overview the research on different aspects of bacterial ribosomes, especially focus on discussing the challenges in the discovery of ribosome‐targeting antibacterial drugs and advances made to address issues such as drug‐resistance and selectivity, which, we believe, provide perspectives for the discovery of novel antibiotics.

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Linezolid-induced pure red cell aplasia: a case report and literature review

Cited by 10 publications

References 21 publications

Linezolid-Induced Pure Red Cell Aplasia: A Case Report

Linezolid-Induced Pure Red Cell Aplasia: A Case Report

Concise Clinical Review of Hematologic Toxicity of Linezolid in Multidrug-Resistant and Extensively Drug-Resistant Tuberculosis: Role of Mitochondria

Ribosome‐targeting antibacterial agents: Advances, challenges, and opportunities

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