Linezolid-induced Posterior Reversible Encephalopathy Syndrome: A Case Report and Review of the Literature

Posterior reversible encephalopathy syndrome (PRES) is a neurotoxic condition characterized by vasogenic edema, altered mental status (AMS), seizures, headaches, and visual disturbances. It is commonly associated with hypertension, cytotoxic drugs, and autoimmune disorders. We report a rare case of PRES likely related to linezolid therapy.

A 77-year-old female with renal cell carcinoma, rheumatoid arthritis, hypertension, and prior thromboembolic events underwent major abdominal surgery complicated by coagulopathy, hemorrhage, and sepsis. Blood cultures grew Enterococcus faecium , and linezolid was initiated. Within 48 hours, she developed AMS and respiratory distress requiring intubation. EEG showed epileptiform discharges, and MRI revealed subarachnoid and intraparenchymal hemorrhage with features of PRES. Linezolid was discontinued, and follow-up MRI demonstrated improvement in bilateral hemispheric edema and hemorrhage. A literature review identified 2 additional cases of linezolid-associated PRES, both with similar neurological symptoms but without hemorrhagic complications. Unlike prior reports, our patient had a prolonged recovery, with only partial improvement at 19 days, likely influenced by comorbidities and associated hemorrhagic lesion.

Linezolid-induced PRES is rare but clinically significant. Our case highlights potential hemorrhagic complications and delayed recovery, underscoring the need for early recognition and prompt management.