title: Linezolid-induced optic neuropathy with a rare pathological change in the inner retina.
abstract: We report a case of linezolid-induced optic neuropathy with transient microcystic spaces in the inner retina. We observed the retina using Fourier-domain optical coherence tomography (FD-OCT) in a patient with linezolid-induced optic neuropathy. A 49-year-old woman presented to our department with a 1-week history of bilateral photophobia. At the first visit, her best-corrected visual acuity (VA) was 0.6 in the right eye and 0.5 in the left eye. She had moderate optic disk edema and central scotomas bilaterally. FD-OCT showed bilateral microcystic spaces in the retina. Microcystic spaces were seen in the retinal nerve fiber layer (RNFL) and at the border of the RNFL and the retinal ganglion cell layer. Magnetic resonance imaging and laboratory tests showed no positive findings except for an elevated lactic acid level. One week after the first visit, the VA levels decreased to 0.06 and 0.07 in the right and left eyes, respectively. Because the patient had a 7-month history of linezolid treatment for persistent pyogenic arthritis, we suspected linezolid-induced optic neuropathy and immediately terminated treatment with this drug. The optic disk edema and the microcystic spaces in the retina resolved, and the VA improved to 1.2 at 6 weeks after linezolid withdrawal. Microcystic spaces, which resolved with linezolid withdrawal, were observed in linezolid-induced optic neuropathy. The microcystic spaces in the inner retina can be the first retinal sign of some optic neuropathies.
authors.affiliation: Department of Ophthalmology, Asahikawa Medical University, Asahikawa, Japan.
authors.forename: Nobuhito
authors.initials: N
authors.lastname: Ishii
authors.affiliation: Department of Ophthalmology, Asahikawa Medical University, Asahikawa, Japan. rkino@asahikawa-med.ac.jp.|Department of Medicine and Engineering Combined Research, Asahikawa Medical University, Hokkaido, Midorigaoka Higashi 2-1-1-1, Asahikawa, 078-8510, Japan. rkino@asahikawa-med.ac.jp.
authors.forename: Reiko
authors.initials: R
authors.lastname: Kinouchi
authors.affiliation: Department of Hospital Pharmacy and Pharmacology, Asahikawa Medical University, Hokkaido, Asahikawa, Japan.
authors.forename: Masatomo
authors.initials: M
authors.lastname: Inoue
authors.affiliation: Department of Ophthalmology, Asahikawa Medical University, Asahikawa, Japan.
authors.forename: Akitoshi
authors.initials: A
authors.lastname: Yoshida
mesh_terms: D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D005260:Female; D006801:Humans; D000069349:Linezolid / Q000009:adverse effects*; D008875:Middle Aged; D009901:Optic Nerve Diseases / Q000139:chemically induced* / Q000473:pathology
chemical_list: D000900:Anti-Bacterial Agents; D000069349:Linezolid
keywords: Ganglion cell complex; Linezolid; Microcystic spaces; Retinal nerve fiber layer