Pure red cell precursor toxicity by linezolid in a pediatric case.
Linezolid (LZD)-induced myelosuppression has been reported in adults; however, LZD-induced pure red cell precursor toxicity rarely occurs. A 2-year-old boy diagnosed with infective endocarditis by Streptococcus mitis received LZD after developing resistance to multiple antibiotics. Although his infective symptoms were improved by LZD, progressive anemia was noticed 2 weeks after LZD therapy. Four weeks after LZD administration, his hemoglobin level was 6.5 g/dL and reticulocytes less than 0.1%. Bone marrow examination revealed markedly decreased erythropoiesis with cytoplasmic vacuolation of erythroblasts. Anemia recovered 19 days after cessation of LZD. Elevated protoporphyrin and a high LZD level in the blood suggested that mitochondrial disturbance by high-dose and long-term treatment with LZD may have been responsible for LZD-induced pure red cell precursor toxicity.
Taketani
Takeshi
T
Division of Blood Transfusion, Shimane University Hospital, Izumo, Shimane, Japan. ttaketani@med.shimane-u.ac.jp
Kanai
Rie
R
Fukuda
Seiji
S
Uchida
Yuri
Y
Yasuda
Kenji
K
Mishima
Seiji
S
Suyama
Tamiko
T
Kodama
Rumi
R
Yoshino
Isao
I
Kunishi
Hiroyuki
H
Yamaguchi
Seiji
S
Masuda
Junichi
J
D000081:Acetamides / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use; D002675:Child, Preschool; D024901:Drug Resistance, Multiple, Bacterial; D004697:Endocarditis, Bacterial / Q000188:drug therapy*; D017707:Erythrocyte Transfusion; D015672:Erythroid Precursor Cells / Q000187:drug effects; D005294:Ferrochelatase / Q000037:antagonists & inhibitors; D006801:Humans; D000069349:Linezolid; D008297:Male; D008928:Mitochondria / Q000187:drug effects; D023303:Oxazolidinones / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use; D011524:Protoporphyrins / Q000097:blood; D012010:Red-Cell Aplasia, Pure / Q000139:chemically induced* / Q000628:therapy; D012270:Ribosomes / Q000187:drug effects; D013290:Streptococcal Infections / Q000188:drug therapy*; D034361:Streptococcus mitis / Q000187:drug effects
D000081:Acetamides; D000900:Anti-Bacterial Agents; D023303:Oxazolidinones; D011524:Protoporphyrins; D005294:Ferrochelatase; D000069349:Linezolid