title: Painful neuropathy with skin denervation after prolonged use of linezolid.
abstract: The prolonged use of linezolid, a new antibiotic against drug-resistant gram-positive pathogens, might cause painful neuropathy. This finding raises the possibility that small-diameter sensory nerves in the skin, which are responsible for transmitting nociceptive information, might be affected. We report a 53-year-old female who developed pure small-fibre painful neuropathy (visual analogue scale, VAS = 82 on 0-100 scale) with marked skin denervation in the leg (epidermal nerve density, END = 2.32 fibres/mm, norm <5.88 fibres/mm) and significant elevation of the warm threshold in the foot (40.0 degrees C, norm <39.4 degrees C) after the use of linezolid for 6 months. Eight months after the discontinuation of linezolid, the skin became fully reinnervated (END = 9.04 fibres/mm), with disappearance of neuropathic pain (VAS = 0) and normalisation of the warm threshold (36.3 degrees C). Nerve conduction studies for large-diameter motor and sensory nerves were normal. This report documents a pure small-fibre sensory neuropathy after prolonged use of linezolid, and the relationship between skin innervation and corresponding neuropathic pain.
authors.affiliation: Department of Neurology, National Taiwan University Hospital, 7 Chung-Shan S. Road, Taipei 10002, Taiwan.
authors.forename: C-C
authors.initials: CC
authors.lastname: Chao
authors.forename: H-Y
authors.initials: HY
authors.lastname: Sun
authors.forename: Y-C
authors.initials: YC
authors.lastname: Chang
authors.forename: S-T
authors.initials: ST
authors.lastname: Hsieh
mesh_terms: D000081:Acetamides / Q000009:adverse effects* / Q000627:therapeutic use; D000890:Anti-Infective Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001706:Biopsy; D004817:Epidermis / Q000187:drug effects / Q000294:innervation / Q000473:pathology; D005260:Female; D006801:Humans; D000069349:Linezolid; D008875:Middle Aged; D009431:Neural Conduction / Q000187:drug effects; D023303:Oxazolidinones / Q000009:adverse effects* / Q000627:therapeutic use; D010146:Pain / Q000139:chemically induced* / Q000175:diagnosis / Q000503:physiopathology*; D011984:Sensory Receptor Cells / Q000187:drug effects* / Q000503:physiopathology; D012867:Skin / Q000187:drug effects* / Q000294:innervation* / Q000473:pathology; D013290:Streptococcal Infections / Q000188:drug therapy; D013997:Time Factors
chemical_list: D000081:Acetamides; D000890:Anti-Infective Agents; D023303:Oxazolidinones; D000069349:Linezolid