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A case of lactic acidosis induced by linezolid

Nature Reviews Nephrology volume 6, pages 236–242 (2010)Cite this article

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Abstract

Background. A 36-year-old African American man with end-stage renal disease on chronic maintenance hemodialysis was transferred first from a hospital to a long-term acute care facility for advanced care then to the intensive care unit of our university hospital with unexplained abdominal pain, nausea, hypotension, altered mental status and anion gap metabolic acidosis. Subsequent review of the patient's medication list revealed that the he had been on linezolid for 6 weeks for the treatment of vancomycin-resistant Enterococcus fecalis bacteremia.

Investigations. Medical history, physical examination, laboratory tests, CT imaging of the thorax, abdomen and pelvis and PCR-based tests to determine the presence of polymorphisms in the 16S ribosomal RNA gene.

Diagnosis. Lactic acidosis associated with prolonged exposure to linezolid.

Management. Discontinuation of linezolid.

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Figure 1: Clinical course of the case patient.
Figure 2: Mechanism by which linezolid inhibits protein translation by the bacterial initiation complex.

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Acknowledgements

The research work of Dr. J. C. Q. Velez is supported by a NIH NIDDK K08 Career Development Award. The research work of Dr. M. G. Janech is supported by a Veterans Affairs CDA-2 Career Development Award and the Nephcure Foundation.

Charles P. Vega, University of California, Irvine, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the MedscapeCME continuing medical education activity associated with this article.

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Authors and Affiliations

  1. Division of Nephrology, Department of Medicine, Medical University of South Carolina, 96 Jonathan Lucas Street, Clinical Sciences Building, Room 829, Charleston, 29425, SC, USA

    Juan Carlos Q. Velez

  2. Medical and Research Services, Ralph H. Johnson, VA Medical Center, Charleston,

    Michael G. Janech

  3. 114 Doughty Street, Strom Thurmond Building, Room 202, Charleston, 29403, SC, USA

    Michael G. Janech

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Correspondence to Juan Carlos Q. Velez.

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Competing interests

The authors, the Journal Editor S. Allison and the CME questions author C. P. Vega declare no competing interests.

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Velez, J., Janech, M. A case of lactic acidosis induced by linezolid. Nat Rev Nephrol 6, 236–242 (2010). https://doi.org/10.1038/nrneph.2010.20

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