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A Case Involving Linezolid-induced Fatal Lactic Acidosis and Pancytopenia.

Kundan Mehta1, Rhea Gandhi2, Islahuzzama Salahuddin Ansari3

  • 1Associate Professor, Department of Respiratory Medicine, Dr D Y Patil Medical College, Hospital and Research Centre, Dr D Y Patil Vidyapeeth University, Pune, Maharashtra, India.

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A patient with multidrug-resistant pulmonary tuberculosis developed severe lactic acidosis, a fatal complication linked to linezolid treatment. This case highlights the critical need for careful monitoring during treatment for drug-resistant tuberculosis.

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Area of Science:

  • Medicine
  • Pharmacology
  • Infectious Diseases

Background:

  • Multidrug-resistant pulmonary tuberculosis (MDR-PTB) requires complex treatment regimens.
  • Longer all-oral regimens are increasingly used, guided by programs like India's PMDT.
  • Linezolid is a key component in treating MDR-PTB.

Observation:

  • A 77-year-old female with MDR-PTB presented with gastrointestinal distress and worsening dyspnea.
  • She developed pancytopenia and progressively increasing lactate levels.
  • Other causes of lactic acidosis were excluded.

Findings:

  • Severe lactic acidosis was identified as the cause of death.
  • The lactic acidosis was strongly associated with linezolid therapy.
  • This complication occurred despite adherence to the Indian PMDT guidelines for MDR-PTB.

Implications:

  • This case underscores the potential for severe, life-threatening lactic acidosis with linezolid use in MDR-PTB patients.
  • Vigilant monitoring for metabolic complications, particularly lactic acidosis, is crucial during linezolid treatment.
  • Further research into risk factors and early detection of linezolid-induced lactic acidosis is warranted.