Early Linezolid-associated Lactic Acidosis in a Patient Treated for Tuberculous Spondylodiscitis

摘要

The oxazolidinone antibiotic linezolid is used to treat gram-positive infections , including those due to methicillin-resistantStaphylococcus aureus, vancomycin-resistant enterococci and penicillin-resistant pneumococci. The drug has been recently proposed as a valid alternative in the management of multidrug-resistant tuberculosis , although its prolonged use has been associated with severe toxicity, particularly myelosuppression, peripheral or optic neuropathy, and serotonin toxicity . Linezolid-induced lactic acidosis has been also reported in patients treated for gram-positive infections for several weeks . There are evidences that linezolid inhibits mitochondrial bacterial protein synthesis , and mitochondrial toxicity may be also the underlying pathophysiological mechanism of lactic acidosis and peripheral or optic neuropathy. No cases of lactic acidosis in patients treated with linezolid for tuberculosis were reported in the literature up to date, while there are reports of lactic acidosis induced by isoniazid over dosage . We report a case in which severe lactic acidosis developed early possibly as an adverse effect of linezolid treatment in a patient with tuberculous spondylodiscitis.