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Peripheral neuropathy associated with prolonged use of linezolid

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Summary

We present a case of a woman who developed severe, painful peripheral neuropathy while receiving linezolid therapy for 6 months. Nerve conduction studies indicated a sensory-motor axonal neuropathy. Extensive assessment did not show alternative explanations for her neuropathy. At the time of death 1 month after discontinuing linezolid, the neuropathy had not resolved. A review of published material shows a growing body of evidence that long-term use of linezolid may be associated with severe peripheral and optic neuropathy. 21 cases have been reported. In most cases, optic neuropathies resolved after stopping linezolid but peripheral neuropathies did not. The duration of therapy rather than indication for treatment seems to be the most important factor. The mechanism of toxicity is unknown but certain pharmacological properties of linezolid that may play a part are proposed. This report highlights the importance of post-approval surveillance and reporting of serious adverse drug effects, and potential consequences of off-label use of pharmaceuticals. It further demonstrates the critical role clinicians have in communicating awareness of emerging drug toxicities.

Section snippets

Case presentation

The patient is a 46-year-old white woman with a history of chronic obstructive pulmonary disease and obstructive sleep apnoea, first hospitalised with respiratory failure at another facility in February 2002. During that hospitalisation, she developed catheter-associated bacteraemia with meticillinresistant Staphylococcus aureus (MRSA) complicated by osteomyelitis at the T9-T10 vertebrae. The site was surgically debrided several times and the woman eventually underwent spinal fusion with

Review and discussion

Before its release in 2002, the only significant toxicity identified in clinical trials of linezolid was a low incidence of myelosuppresion.1 As with any medication, widespread use after release provides greater opportunity to identify rare side effects. A review of the most recent published material as well as abstracts identified by the manufacturer show a small but concerning body of evidence linking linezolid to serious peripheral neuropathy.

The largest published series of linezolid use

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