Pure red cell precursor toxicity by linezolid in a pediatric case.

Author(s): Taketani T, Kanai R, Fukuda S, Uchida Y, Yasuda K, Mishima S, Suyama T, Kodama R, Yoshino I, Kunishi H, Yamaguchi S, Masuda J

Affiliation(s): Division of Blood Transfusion, Shimane University Hospital, Izumo, Shimane, Japan. ttaketani@med.shimane-u.ac.jp

Publication date & source: 2009-09, J Pediatr Hematol Oncol., 31(9):684-6.

Publication type: Case Reports

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.