Wiyana Yovil Bagas, Marhana Isnin Anang, Suhartono Gatot, Haryono Andreas
Department of Pulmonology and Respiratory Medicine, Faculty of Medicine Universitas Airlangga-Dr. Soetomo General Academic Hospital, Surabaya, Indonesia.
Department of Ophthalmology, Faculty of Medicine Universitas Airlangga-Dr. Soetomo General Academic Hospital, Surabaya, Indonesia.
Case Rep Pulmonol. 2025 Jul 27;2025:9939815. doi: 10.1155/crpu/9939815. eCollection 2025.
Multidrug-resistant tuberculosis (MDR-TB) is characterized by resistance to at least isoniazid and rifampicin. Linezolid is an antibiotic used for drug-resistant Gram-positive bacteria and is a treatment option for MDR-TB. However, its use is associated with optic neuropathy, presenting as acute worsening and bilateral vision loss, typically within 4 months of therapy. A 47-year-old male with MDR-TB relapsed during the sixth month of an individualized treatment regimen at Dr. Soetomo General Academic Hospital, Surabaya. The patient presented with weakness and anemia, receiving a regimen including levofloxacin (750 mg), linezolid (600 mg), clofazimine (100 mg), and cycloserine (500 mg). In the ninth month, the patient developed visual disturbances, initially suspected to be caused by an intracranial tumor. Despite various examinations and treatments, there was no improvement until linezolid was discontinued. The patient's visual complaints gradually improved following the cessation of linezolid therapy. This case underscores the potential for linezolid to cause optic neuropathy during prolonged treatment for MDR-TB. Detailed ophthalmologic examinations, including optical coherence tomography (OCT) and magnetic resonance imaging (MRI), confirmed optic neuropathy without intracranial pathology. Despite high-dose steroid therapy, the patient's vision improved only after 1 month since discontinuing linezolid. This highlights the importance of monitoring for ocular toxicity in patients undergoing long-term linezolid therapy and suggests that timely intervention can prevent permanent visual impairment. The case demonstrates the reversible nature of linezolid-induced optic neuropathy upon drug cessation and emphasizes the need for regular ophthalmologic assessments in patients receiving prolonged linezolid treatment. This report contributes to the understanding of the adverse effects of linezolid and underscores the importance of vigilant monitoring and alternative therapeutic strategies for MDR-TB.
耐多药结核病（MDR-TB）的特征是对至少异烟肼和利福平耐药。利奈唑胺是一种用于耐药革兰氏阳性菌的抗生素，是耐多药结核病的一种治疗选择。然而，其使用与视神经病变有关，表现为急性加重和双侧视力丧失，通常在治疗的4个月内出现。一名47岁男性，在泗水苏托莫综合学术医院接受个体化治疗方案的第6个月时，耐多药结核病复发。该患者出现虚弱和贫血，接受了包括左氧氟沙星（750毫克）、利奈唑胺（600毫克）、氯法齐明（100毫克）和环丝氨酸（500毫克）的治疗方案。在第9个月时，患者出现视觉障碍，最初怀疑是由颅内肿瘤引起的。尽管进行了各种检查和治疗，但直到停用利奈唑胺后才有所改善。停用利奈唑胺治疗后，患者的视觉症状逐渐改善。该病例强调了利奈唑胺在耐多药结核病长期治疗期间导致视神经病变的可能性。详细的眼科检查，包括光学相干断层扫描（OCT）和磁共振成像（MRI），证实为视神经病变，无颅内病变。尽管进行了高剂量的类固醇治疗，但患者的视力仅在停用利奈唑胺1个月后才有所改善。这突出了在接受长期利奈唑胺治疗的患者中监测眼部毒性的重要性，并表明及时干预可以预防永久性视力损害。该病例证明了利奈唑胺引起的视神经病变在停药后具有可逆性，并强调了在接受长期利奈唑胺治疗的患者中进行定期眼科评估的必要性。本报告有助于了解利奈唑胺的不良反应，并强调了对耐多药结核病进行警惕监测和替代治疗策略的重要性。
