Reversible recurrent profound thrombocytopenia due to linezolid in a patient with multi-drug resistant tuberculosis: A case report.

RATIONALE

Thrombocytopenia caused by linezolid (LZD) is common, with a reported prevalence as high as 11.8%. Platelets typically reach normal levels 7 days after LZD withdrawal. However, recurrent profound thrombocytopenia due to LZD usage and a persistent profound drop in platelet count after LZD withdrawal have not been reported.

PATIENT CONCERNS

We report a case of a 75-year-old woman, who presented with recurrent profound thrombocytopenia induced by LZD treatment for multidrug-resistant tuberculosis (MDR-TB).

DIAGNOSES

Laboratory data and symptoms during and after LZD usage and reusage indicated severe thrombocytopenia.

INTERVENTIONS

LZD was discontinued due to recurrent thrombocytopenia and the platelet count continued to drop for 9 days and returned to normal gradually 16 days after LZD withdrawal and supportive care including platelet transfusion.

OUTCOMES

There was no recurrence of thrombocytopenia during 10 months of follow-up during treatment for MDR-TB with a regimen without LZD.

LESSONS

Recurrent profound thrombocytopenia can happen after several doses of LZD rechallenging. Therefore, reuse of LZD should be avoided after recovery from severe thrombocytopenia due to LZD.