Linezolid-induced lactic acidosis.

Area of Science:

• Infectious Diseases
• Pharmacology
• Critical Care Medicine

Background:

• Linezolid is a crucial antibiotic for treating multidrug-resistant Gram-positive infections.
• Common side effects include thrombocytopenia and peripheral neuropathy with prolonged use.
• Lactic acidosis is a rare but severe adverse drug reaction associated with linezolid.

Observation:

• A patient with disseminated multidrug-resistant tuberculosis developed vomiting, dyspnea, hypotension, and high anion gap metabolic acidosis.
• Initial symptoms mimicked sepsis, but extensive investigations ruled out infection, ketoacidosis, renal dysfunction, and toxin ingestion.
• Linezolid was discontinued due to suspected linezolid-induced lactic acidosis (LILA).

Findings:

• Following linezolid discontinuation, the patient's lactic acidosis resolved, and their clinical condition improved.
• This clinical course supported a retrospective diagnosis of LILA.
• The case highlights the importance of considering LILA in patients presenting with unexplained lactic acidosis while on linezolid therapy.

Implications:

• LILA should be considered in the differential diagnosis for patients on linezolid who develop lactic acidosis.
• Early recognition and discontinuation of linezolid may prevent severe complications.
• This case underscores the need for vigilance regarding rare adverse drug reactions to commonly used antibiotics.