Title : Linezolid-induced bicytopenia in a patient with end-stage renal disease: A case report
Abstract:
Aim: Linezolid (LZD) is an oxazolidinone antibiotic with potent activity against methicillin-resistant Staphylococcus aureus (MRSA). While thrombocytopenia is a recognized side effect, concurrent anemia leading to bicytopenia is less frequently documented. The aim of this study is to report a case of severe LZD-induced bicytopenia in a patient with renal impairment to emphasize the necessity of hematological monitoring beyond standard guidelines.
Methods: A clinical case review was conducted for a female patient receiving LZD (600 mg orally twice daily) for confirmed MRSA osteomyelitis. Clinical data, including serial complete blood counts (CBC), medication history, and diagnostic workups were analyzed. Adverse events were graded using the Common Terminology Criteria for Adverse Events (CTCAE) and causality was determined via the Naranjo Adverse Drug Reaction Probability Scale (NADRPS).
Results: A patient with end-stage renal disease (ESRD) on hemodialysis began LZD therapy with a baseline hemoglobin (Hgb) of 9.4 g/dL and platelet (PLT) count of 136 K/μL. On day 18 of therapy, she developed significant bicytopenia with a nadir PLT count of 48 K/μL and an Hgb level of 6.8 g/dL, corresponding to CTCAE Grade 3 thrombocytopenia and Grade 3 anemia. The NADRPS score was 6, indicating a probable drug-induced etiology. Following the immediate discontinuation of LZD, PLT counts began to recover within 5 days, and all hematological parameters returned to baseline within 1 week.
Conclusion: This case illustrates a high risk of bicytopenia in individuals with ESRD receiving LZD. Renal impairment significantly increases the risk of hematologic toxicity, particularly during prolonged therapy. The degree of renal function must be considered when prescribing LZD, and further evidence is needed regarding dose adjusted therapy to mitigate bicytopenia in high-risk populations.
