Stephen J.LurieMD, PhD, Senior EditorIndividualAuthorJody W.ZylkeMD, Contributing EditorIndividualAuthor
To the Editor: In their Research Letter, Dr
Green and colleagues1 reported 3 cases of
myelosuppression with red cell hypoplasia that occurred during linezolid therapy.
We report here a case of reversible sideroblastic anemia that appeared within
2 months of linezolid treatment.
A 61-year-old man with chronic leg osteomyelitis due to Staphylococcus aureus, Enterococcus faecalis,
and Morganella morganii was treated by debridement
surgery and antibiotics including linezolid (600 mg twice daily) and ofloxacin
(400 mg twice daily) for 60 days. He was also receiving ranitidine. During
this period, platelet and leukocyte counts remained stable while hemoglobin
concentration progressively decreased from 15.4 to 7.8 g/dL. Anemia was microcytic
(mean corpuscular volume 83 fL), with a reticulocyte count of 28 × 103/µL. Vitamin B12, folate, and ferritin serum levels were normal.
Serum iron was increased at 219 µg/dL (normal, <175 µg/dL)
and transferrin level was reduced at 150 mg/dL (normal, >200 mg/dL). Bone
marrow examination showed dyserythropoiesis with megaloblastosis, vacuolated
proerythroblasts, and more than 15% of pathognomonic ringed sideroblasts.
The administration of linezolid was interrupted and ranitidine was replaced
by omeprazole. The patient also received 2 units of packed red blood cells.
Three weeks after linezolid discontinuation, hemoglobin level was normal with
a marked increase of reticulocytosis (150 ×103/µL).
Abena PA, Mathieux VG, Scheiff J, Michaux LM, Vandercam BC. Linezolid and Reversible Myelosuppression. JAMA. 2001;286(16):1973-1974. doi:10.1001/jama.286.16.1969