Allison Glenn W, Perla Rocco J, Belliveau Paul P, Angelis Sheryn M
Quality and Safety, Hospital Medicine Program, MetroWest Medical Center, Framingham, MA 01702, USA.
Am J Health Syst Pharm. 2009 Jun 15;66(12):1097-100. doi: 10.2146/ajhp080228.
A case of elevated creatine phosphokinase (CPK) levels associated with linezolid therapy in a patient on chronic antihyperlipidemic therapy is presented.
A 79-year-old Caucasian man with a primary diagnosis of acute hemoptysis secondary to pneumonia was admitted to the medical-surgical intensive care unit. A chest radiograph showed a large, right, lower-lobe infiltrate with alveolar consolidation. The patient's medical history included hyperlipidemia that was chronically treated with lovastatin and gemfibrozil. Methicillin-resistant Staphylococcus aureus (MRSA) pneumonia was suspected and confirmed. Vancomycin 1 g i.v. every 12 hours was administered for approximately 10 days into the admission and switched to linezolid 600 mg i.v. every 12 hours after a lack of response to vancomycin. On hospital day 11, the patient's CPK concentration was 47 units/L. Seven days later, his CPK concentration was 2584 units/L and his lovastatin and gemfibrozil were discontinued on that day. The patient's CPK concentration peaked at 5369 units/L on the following day, and linezolid was discontinued at that point. One week later, his CPK concentration was 28 units/L. Approximately two weeks after the patient's CPK levels normalized, he developed numerous complications. The patient died as a result of respiratory failure 11 days after being extubated, which occurred about 38 days after his admission. Although concomitant use of statins and gemfibrozil is known to increase the risk for CPK elevations, the continued rise in CPK levels after discontinuation of antihyperlipidemic therapy and the rapid time course for normalization after linezolid discontinuation are more consistent with an event associated with linezolid initiation.
A patient on chronic antihyperlipidemic therapy developed elevated CPK levels after receiving linezolid for the treatment of MRSA pneumonia.
报告1例接受慢性抗高脂血症治疗的患者在使用利奈唑胺治疗期间出现肌酸磷酸激酶（CPK）水平升高的病例。
一名79岁的白人男性，初步诊断为肺炎继发急性咯血，入住内科-外科重症监护病房。胸部X线片显示右肺下叶有大片浸润影伴肺泡实变。患者有高脂血症病史，长期服用洛伐他汀和吉非贝齐治疗。怀疑并确诊为耐甲氧西林金黄色葡萄球菌（MRSA）肺炎。入院时静脉注射万古霉素1g，每12小时1次，持续约10天，在对万古霉素无反应后改为静脉注射利奈唑胺600mg，每12小时1次。住院第11天，患者CPK浓度为47单位/L。7天后，其CPK浓度为2584单位/L，当日停用洛伐他汀和吉非贝齐。次日患者CPK浓度峰值达到5369单位/L，此时停用利奈唑胺。1周后，其CPK浓度为28单位/L。患者CPK水平恢复正常约两周后，出现了许多并发症。患者拔管11天后因呼吸衰竭死亡，拔管发生在入院后约38天。虽然已知他汀类药物和吉非贝齐联合使用会增加CPK升高的风险，但停用抗高脂血症治疗后CPK水平持续升高，以及停用利奈唑胺后CPK水平迅速恢复正常，更符合与开始使用利奈唑胺相关的事件。
1例接受慢性抗高脂血症治疗的患者在接受利奈唑胺治疗MRSA肺炎后出现CPK水平升高。
