Lactic acidosis associated with standard dose linezolid in a kidney recipient with impaired renal function

• Published in: The Brazilian journal of infectious diseases Vol. 26; no. 1; p. 101701
• Main Authors: Chen, Chien-Chou, Liu, Wei-Ting, Lin, Shih-Hua
• Format: Journal Article
• Language: English
• Published: Brazil Elsevier España, S.L.U 01-01-2022; Contexto; Elsevier; Brazilian Society of Infectious Diseases
• Subjects: Acidosis, Lactic - chemically induced; Acidosis, Lactic - diagnosis; Adult; Case Report; Case studies; Chronic kidney disease; Complications and side effects; Dosage and administration; Drug therapy; Humans; INFECTIOUS DISEASES; Kidney - physiology; Kidney failure; Kidneys; Lactic acidosis; Linezolid; Linezolid - adverse effects; Male; Organ transplant recipients; Risk factors; Transplantation; Taiwan; Linezolid; eGFR; NTM; LZD; Chronic kidney disease; TDM; Lactic acidosis; CKD
• ISSN: 1413-8670; 1678-4391; 1678-4391
• DOI: 10.1016/j.bjid.2021.101701

Severe lactic acidosis, a mitochondrial toxicity caused by the recommended standard dosage of linezolid (LZD), may occur in patients with impaired renal function. We describe an adult male who underwent kidney transplantation with stably impaired renal function, severe dyspnea, and abdominal discomfort. He received a standard oral dose of LZD (600 mg twice daily) and azithromycin for three weeks with a reduced immunosuppressant dose due to pulmonary non-tuberculosis mycobacterial infection. He was alert and afebrile, with a blood pressure of 140/60 mmHg. Pertinent laboratory data showed: pH 7.12, PaCO2 13.6 mmHg; HCO3- 4.3 mmol/L and serum lactate 18.4 mmol/L. His trough serum LZD concentration reached toxic levels (21.4 μg/mL). With hemodialysis, his clinical symptoms improved, with a decline in serum LZD (9.8μg/mL) and lactate (3.2 mmol/L). Chronic standard dose LZD in patients with impaired renal function can lead to life-threatening lactic acidosis, especially in coexisting conditions that reduce LZD metabolism.