Journal of Neurology

, Volume 257, Issue 3, pp 433–435 | Cite as

Early onset probable linezolid-induced encephalopathy

  • Jeffery Fletcher
  • Laura E. Aykroyd
  • Eric C. Feucht
  • James M. Curtis
Original Communication


Linezolid is increasingly being utilized for the treatment of Gram-positive pathogens. While neurological complications with linezolid are rare, long-term exposure can be associated with neurotoxic effects. Patients with pre-existing neurologic sequelae or risk factors, such as alcohol abuse, diabetes, or concomitant administration of chemotherapeutic agents and/or antiretroviral therapy, may be more susceptible to the development of linezolid-induced neurotoxicity. We describe a 41-year-old male who developed early onset encephalopathy after a day and a half of linezolid therapy. Our patient had at least one significant risk factor (alcoholism), making linezolid-induced encephalopathy probable based upon the Naranjo probability scale. Clinicians should be aware of the potential for early onset linezolid-induced neurotoxicity, particularly in patients with concomitant risk factors.


Linezolid Encephalopathy Alcohol abuse 


  1. 1.
    Pharmacia & Upjohn. Zyvox (linezolid) package insert. Kalamazoo, MI 2000 (revised 2006)Google Scholar
  2. 2.
    Bishop E, Melvani S, Howden BP, Charles PG, Grayson MI (2006) Good clinical outcomes but high rates of adverse reactions during linezolid therapy for serious infections: a proposed protocol for monitoring therapy in complex patients. Antimicrob Agents Chemother 50:1599–1602CrossRefPubMedGoogle Scholar
  3. 3.
    Kopterides P, Papadomichelakis E, Armaganidis A (2005) Linezolid use associated with lactic acidosis. Scand J Infect Dis 37:153–154CrossRefPubMedGoogle Scholar
  4. 4.
    Ferry T, Ponceau B, Simon M, Issartel B, Petiot P et al (2005) Possibly linezolid-induced peripheral and central neurotoxicity: report of four cases. Infection 33(3):151–154CrossRefPubMedGoogle Scholar
  5. 5.
    Nagel S, Kohrmann M, Huttner HB, Storch-Hagenlocher B et al (2007) Linezolid-induced posterior reversible leukoencephalopathy syndrome. Arch Neurol 64(5):746–748CrossRefPubMedGoogle Scholar
  6. 6.
    Azamfirei L, Copotoiu SM, Branzaniuc K, Szederjesi J et al (2007) Complete blindness after optic neuropathy induced by short-term treatment in a patient suffering from muscle dystrophy. Pharmacoepidemiol Drug Saf 16(4):402–404CrossRefPubMedGoogle Scholar
  7. 7.
    Narita M, Tsuji BT, Yu VL (2007) Linezolid-associated peripheral and optic neuropathy, lactic acidosis, and serotonin syndrome. Pharmacotherapy 27(8):1189–1197CrossRefPubMedGoogle Scholar
  8. 8.
    De Vriese AS, Coster RV, Smet J, Seneca S, Lovering A et al (2006) Linezolid-induced inhibition of mitochondrial protein synthesis. Clin Infect Dis. 42(8):1111–1117CrossRefPubMedGoogle Scholar
  9. 9.
    Soriano A, Miro O, Mensa J (2005) Mitochondrial toxicity associated with linezolid [letter]. N Engl J Med 353:2305–2306CrossRefPubMedGoogle Scholar
  10. 10.
    Palenzuela L, Hahn NM, Nelson RP, Arno JN, Schobert C et al (2005) Does linezolid cause lactic acidosis by inhibiting mitochondrial protein synthesis? Clin Infect Dis 40:e113–e116CrossRefPubMedGoogle Scholar
  11. 11.
    Leach KL, Swaney SM, Colca JR, McDonald WG, Blinn JR et al (2007) The site of action of oxazolidinone antibiotics in living bacteria and in human mitochondria. Mol Cell 26(3):393–402CrossRefPubMedGoogle Scholar
  12. 12.
    McKee EE, Ferguson M, Bentley AT, Marks TA (2006) Inhibition of mammalian mitochondrial protein synthesis by oxazolidinones. Antimicrob Agents Chemother 50(6):2042–2049CrossRefPubMedGoogle Scholar
  13. 13.
    Myrianthefs P, Markantonis SL, Vlachos K, Anagnostaki M et al (2006) Serum and cerebrospinal fluid concentrations of linezolid in neurosurgical patients. Antimicrob Agents Chemother 50(12):3971–3976CrossRefPubMedGoogle Scholar
  14. 14.
    Gill CJ, Murphy MA, Hamer DH (2002) Treatment of Staphylococcus epidermidis ventriculo-peritoneal shunt infection with linezolid. J Infect 45:129–132CrossRefPubMedGoogle Scholar
  15. 15.
    Caplin LR (2006) Cardiac encephalopathy and congestive heart failure. A hypothesis about the relationship. Neurology 66:99–101CrossRefGoogle Scholar
  16. 16.
    Naranjo CA, Busto U, Sellers EM et al (1981) A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther 30(2):239–245PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Jeffery Fletcher
    • 1
    • 2
  • Laura E. Aykroyd
    • 3
  • Eric C. Feucht
    • 4
  • James M. Curtis
    • 5
    • 6
  1. 1. Department of Neurology (Neurocritical Care)Bronson Methodist HospitalKalamazooUSA
  2. 2.Michigan State UniversityLansingUSA
  3. 3.Clinical PharmacyFerris State UniversityBig RapidsUSA
  4. 4.Bronson Methodist HospitalKalamazooUSA
  5. 5.Department of PharmacyBronson Methodist HospitalKalamazooUSA
  6. 6.College of PharmacyFerris State UniversityBig RapidsUSA

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