利奈唑胺(LZD)是第一个具有优异的安全性和功效的恶唑烷酮,可抵抗革兰氏阳性生物体引起的难治性感染。血液毒性,如血小板减少症,贫血,和白细胞减少症在LZD治疗中很常见;然而,LZD诱导的纯红细胞再生障碍(PRCA)很少见。一名被诊断为金黄色葡萄球菌引起的胸膜脓胸的83岁男性在对多种抗生素产生耐药性后接受了LZD。尽管LZD改善了他的感染相关症状,开始LZD治疗后发现进行性贫血.LZD管理开始八周后,血红蛋白水平为5.7g/dL,网织红细胞比例为0.36%,而他的白细胞和血小板计数自入院以来保持不变。骨髓检查显示红细胞生成明显减少,红细胞浆空泡化。LZD停止后14天,贫血消退。重要的是要提高临床医生对与LZD相关的潜在血液学影响的认识,特别是对于既往贫血且疗程超过14天的老年患者。为了检测骨髓抑制,包括PRCA,我们建议定期监测接受长期LZD治疗的患者的全血细胞计数和网织红细胞计数.
Linezolid (LZD) is the first oxazolidinone with excellent safety and efficacy profiles against refractory infections caused by gram-positive organisms. Hematological toxicities such as thrombocytopenia, anemia, and leukocytopenia are common in LZD therapy; however, LZD-induced pure red cell aplasia (PRCA) is rare. An 83-year-old man diagnosed with pleural empyema caused by Staphylococcus aureus received LZD after developing resistance to multiple antibiotics. Although his infection-related symptoms were improved by LZD, progressive anemia was noticed after LZD therapy was initiated. Eight weeks after LZD administration began, his hemoglobin level was 5.7 g/dL and reticulocyte proportion was 0.36%, while his white blood cell and platelet counts remained unchanged since admission. Bone marrow examination revealed markedly decreased erythropoiesis with cytoplasmic vacuolation of erythroblasts. Anemia resolved by 14 days after cessation of LZD. It is important to increase the awareness among clinicians about the potential for the hematological effects associated with LZD, particularly for older patients with pre-existing anemia and treatment courses longer than 14 days. To detect bone marrow suppression, including PRCA, we suggest monitoring the complete blood count and reticulocyte count periodically in patients receiving long-term LZD therapy.