Probable Linezolid‐Induced Pancytopenia

Abstract

A 75-year-old male outpatient with cardiac disease, diabetes, chronic renal insufficiency and iron deficiency anemia was prescribed linezolid 600 mg twice daily for a methicillin-resistant Staphylococcus aureus diabetic foot osteomyelitis. After one week, his blood counts were consistent with baseline values. The patient failed to return for subsequent blood work. On day 26, he was admitted to hospital with acute renal failure secondary to dehydration, and was found to be pancytopenic (erythrocytes 2.5x10(12)/L, leukocytes 2.9x10(9)/L, platelets 59x10(9)/L, hemoglobin 71 g/L). The patient was transfused, and linezolid was discontinued. His blood counts improved over the week and remained at baseline two months later.The patient's decline in blood counts from baseline levels met previously established criteria for clinical significance. Application of the Naranjo scale indicated a probable relationship between pancytopenia and linezolid.Clinicians should be aware of this rare effect with linezolid, and prospectively identify patients at risk and emphasize weekly hematological monitoring.

Reversible Myelosuppresion With Prolonged Usage of Linezolid in Treatment of Methicillin-Resistant Staphylococcus aureus

“…Kuter and Tillotson reported 11 cases out of 13 where pancytopenia occurred after 21 days on linezolid prescription and improved two weeks after withdrawal [9]. Lakhani et al reported pancytopenia in elderly patients receiving linezolid 600 mg twice a day [12]. In our patient, the first symptom appeared 32 days after the start of linezolid therapy and its discontinuation led to resolution of pancytopenia within 21 days.…”

Probable Linezolid-Induced Thrombocytopenia in a Patient With Vancomycin-Resistant Enterococci

“…In this case and a number of other cases involved elderly patients (60 years old or older) receiving linezolid 600 mg twice daily. 7,9–11 Age did not significantly affect linezolid’s pharmacokinetics with single 600 mg oral doses. 21 In addition, our patient had renal dysfunction (creatinine clearance ranged from 40 to 60 mL/min).…”

“…6 Case reports of linezolid-induced thrombocytopenia have been previously published. 7–11 This case of thrombocytopenia is believed to be associated with linezolid therapy in a patient with vancomycin-resistant enterococci (VRE) abdominal infection.…”

Linezolid-induced pancytopenia

“…After the use of linezolid was approved in the USA, there were 72 cases of haematological abnormalities reported among 55 000 patients within the first six months, of the 72 cases reported, pancytopenia accounted for 13 of these cases 2. Lakhani et al reported a further case of pancytopenia with linezolid therapy 6. Though rare, the literature certainly recognises pancytopenia as a side effect.…”