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October 24/31, 2001

Linezolid and Reversible Myelosuppression

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthorJody W.ZylkeMD, Contributing EditorIndividualAuthor


Copyright 2001 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2001

JAMA. 2001;286(16):1973-1974. doi:10.1001/jama.286.16.1969

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).

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