Linezolid-associated acute interstitial nephritis and drug rash with eosinophilia and systemic symptoms (DRESS) syndrome.
Linezolid is a recent addition to the antibiotic armamentarium against Gram-positive bacteria, including multiresistant staphylococci and enterococci. Linezolid is relatively well tolerated and is not believed to be nephrotoxic. However, we report the case of an 88-year-old woman who was treated for prosthetic joint infection and methicillin-resistant Staphylococcus aureus bacteremia with vancomycin followed by linezolid therapy. On day 7 of linezolid treatment, the patient developed severe pruritus, macular rash, facial edema, eosinophilia, marked increase in serum creatinine level, and mild hepatitis. Renal biopsy showed acute interstitial nephritis with eosinophilic cells. Discontinuation of linezolid and a short course of prednisone led to rapid improvement of renal function. This case of linezolid-associated acute interstitial nephritis within the context of a drug rash with eosinophilia and systemic symptoms (DRESS) syndrome in a patient treated with linezolid raises concerns about the presumed renal safety of this drug. Clinicians should be aware of this potential life-threatening adverse reaction and monitor kidney function while patients are using linezolid.
Savard
Sébastien
S
Division of Nephrology, Centre Hospitalier Universitaire de Québec, L'Hôtel-Dieu de Québec Hospital, and Faculty of Medicine, Laval University, Quebec, Canada.
Desmeules
Simon
S
Riopel
Julie
J
Agharazii
Mohsen
M
D000081:Acetamides / Q000009:adverse effects* / Q000627:therapeutic use; D000208:Acute Disease; D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000009:adverse effects* / Q000627:therapeutic use; D004802:Eosinophilia / Q000139:chemically induced* / Q000175:diagnosis; D005076:Exanthema / Q000139:chemically induced* / Q000175:diagnosis; D005260:Female; D006801:Humans; D000069349:Linezolid; D055624:Methicillin-Resistant Staphylococcus aureus; D009395:Nephritis, Interstitial / Q000139:chemically induced* / Q000175:diagnosis; D023303:Oxazolidinones / Q000009:adverse effects* / Q000627:therapeutic use; D016459:Prosthesis-Related Infections / Q000188:drug therapy / Q000382:microbiology; D013203:Staphylococcal Infections / Q000188:drug therapy; D013577:Syndrome; D014640:Vancomycin / Q000627:therapeutic use
D000081:Acetamides; D000890:Anti-Infective Agents; D023303:Oxazolidinones; D014640:Vancomycin; D000069349:Linezolid