Linezolid-associated optic neuropathy in a pediatric patient with Mycobacterium nonchromogenicum

Abstract

Background:Toxic optic neuropathies are alterations of the optic nerve and can be caused by environmental, pharmacological, or nutritional agents.Case:It is about a 7-year-old male patient, a native of the State of Mexico, Mexico who was diagnosed with cervical mycobacterial lymphadenitis that required management with linezolid.Observations:After 7 months of treatment, visual acuity of the left eye decreased and was accompanied by headache. Neuroinfection and other central nervous system affections were discarded. An adverse effect related to treatment with linezolid was suspected, and linezolid was suspended. The symptoms subsided after discontinuation; however, the patient continued to show decreased visual acuity of the left eye, assessed by his ability to count 2 fingers. The right eye remained unaffected.Conclusions:Neurotoxicity can be decreased by reducing the total dose of linezolid or by administrating it in an intermittent form. To avoid progression and loss of vision, we suggest frequent periodic ophthalmological evaluation in patients treated with linezolid.

Linezolid optic neuropathy

“…There have also been reports of patients who suffered significant permanent vision loss, with one patient developing no light perception in both eyes [4,10,15,20,22]. Another case described a 7-year-old child with bilateral optic neuropathy with visual acuity of count-fingers who completely improved in one eye and suffered permanent vision loss with optic nerve atrophy in the other [22]. These cases and data from the literature suggest that LON may not be as reversible as previously reported.…”

“…Data from [5,9–11,15–23,32,34,39 ▪ ,40 ▪ ,41–57,58 ▪ ,59–66]. MRSA, methicillin-resistant staphylococcus aureus; TB, tuberculosis.…”

“…Among those with persistent decreased visual function after drug cessation, significant improvement in vision was still appreciated by most. There have also been reports of patients who suffered significant permanent vision loss, with one patient developing no light perception in both eyes [4,10,15,20,22]. Another case described a 7-year-old child with bilateral optic neuropathy with visual acuity of countfingers who completely improved in one eye and suffered permanent vision loss with optic nerve atrophy in the other [22].…”

Linezolid induced optic neuropathy in a child treated for extensively drug resistant tuberculosis: A case report and review of literature

“…The offending organism was identified as Mycobacterium nonchromogenicum and the patient had developed bilateral disc edema with decrease in visual acuity. On withdrawal of Linezolid the visual acuity of the patient improved in the right eye but the patient developed disc pallor in the left eye and suffered permanent visual impairment 14 …”