International Journal of Infectious Diseases 35 (2015) 120

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Letter to the Editor Linezolid-induced complex partial seizure in a patient without epilepsy Linezolid has most commonly been associated with myelosuppression, peripheral neuropathy, optic neuropathy, and serotonin syndrome, particularly in those with prolonged durations of use (>28 days).1,2 Epileptic seizures are extremely rare. The case of an elderly patient without epilepsy who developed complex partial seizures on day 36 of linezolid treatment is reported below. A 68-year-old female was admitted 4 months after an accidental fall due to progressive difficulty walking. Spinal magnetic resonance imaging (MRI) revealed depressed fractures complicated with spondylodiscitis involving the level 10 and 11 thoracic vertebrae. Cultures obtained from the involved bone and soft tissues yielded methicillin-resistant Staphylococcus aureus (MRSA). She had mild leukocytosis and a markedly elevated Creactive protein (CRP) level, while liver and kidney function were normal. Intravenous linezolid 600 mg every 12 h was initiated. On day 36 of treatment, she developed a ‘complex partial seizure’, so far unique for her, with eyes fixed and deviated to the left side, unresponsiveness to verbal stimuli, and without concomitant motor autonomic symptoms. This seizure lasted for around 15 min. Results of arterial blood gas and biochemistry analyses obtained soon after the seizure revealed no findings of metabolic acidosis or any electrolyte imbalance, including lactate, sodium, and potassium. No significant findings were detected on cranial MRI, however her awake and sleep electroencephalography (EEG) was compatible with postictal period on day 3 after the seizure. An EEG obtained 35 days after the seizure was essentially normal. A 1-hour sleep EEG was normal. She was taking no concomitant medications that could have contributed to the seizure activity. Linezolid was discontinued immediately and the treatment was switched to intravenous daptomycin 6 mg/kg/day. No antiepileptic treatment was initiated and no more seizures or other neurological findings developed during follow-up. To our knowledge, this is the first case of linezolid-induced seizures in a patient with no known epilepsy.3,4 The long-term use of linezolid may induce an epileptic seizure even in those

without epilepsy. Withdrawal of the drug may be sufficient as a measure. Conflict of interest: None declared. References 1. Vinh DC, Rubinstein E. Linezolid: a review of safety and tolerability. J Infect 2009;59(Suppl 1):S59–74. 2. US Food and Drug Administration. Linezolid (marketed as Zyvox) Information. Last updated 24 October, 2011. Available at: www.fda.gov/Safety/MedWatch/ SafetyInformation/SafetyAlertsforHumanMedical Products/ucm265479.htm (accessed January 15, 2014). 3. Shneker BF, Baylin PD, Nakhla ME. Linezolid inducing complex partial status epilepticus in a patient with epilepsy. Neurology 2009;72:378–9. 4. Cholongitas E, Karatzi C, Spyrou S, Georgousaki C, Dasenaki M. Linezolid-induced complex partial seizures in a patient with epilepsy. Scand J Infect Dis 2009;41: 540–1.

Ilker Inanc Balkana,1 Sakir Delilb Elif Rusen Karabacakc Mucahit Yemisena Resat Ozarasa,* Naz Yenib a Department of Infectious Diseases, Istanbul University Cerrahpasa School of Medicine, Cerrahpasa Cad. 34098 Fatih, Istanbul, Turkey b Department of Neurology, Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey c Department of Internal Medicine, Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey *Corresponding author. Tel.: +90 5325165164. E-mail addresses: [email protected] (I.I. Balkan)., [email protected] (R. Ozaras). 1

Tel.: +90 5324095092.

Received 7 November 2014 Received in revised form 30 April 2015 Accepted 1 May 2015

http://dx.doi.org/10.1016/j.ijid.2015.05.007 1201-9712/ß 2015 The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Linezolid-induced complex partial seizure in a patient without epilepsy.

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