Severe linezolid-induced lactic acidosis in a child with acute lymphoblastic leukemia: A case report

Area of Science:

• Pharmacology
• Infectious Diseases
• Critical Care Medicine

Background:

• Linezolid is a vital antibiotic for treating resistant Gram-positive bacterial infections.
• It functions by inhibiting bacterial protein synthesis via mitochondrial ribosome interaction.
• Common adverse effects include gastrointestinal issues, neuropathy, bone marrow suppression, and lactic acidosis.

Observation:

• A rare case of life-threatening lactic acidosis occurred in a 9-year-old female.
• The patient had a history of acute lymphoblastic leukemia (ALL) and hematopoietic stem cell transplant (HSCT).
• Symptoms developed after 51 days of intravenous linezolid for a mycobacterial infection, including vomiting, altered consciousness, and Kussmaul breathing.

Findings:

• The patient experienced severe lactic acidosis, a known but uncommon adverse effect of linezolid.
• Discontinuation of linezolid led to full recovery and normalization of plasma lactate levels.
• This case highlights a severe presentation of linezolid-induced lactic acidosis.

Implications:

• Close monitoring of plasma lactate concentrations is recommended during linezolid therapy.
• Particular vigilance is necessary in patients with pre-existing hepatic or renal dysfunction.
• This underscores the importance of recognizing and managing rare but severe adverse drug reactions.