Linezolid-Induced Pancytopenia in Patients Using Dapagliflozin: A Case Series

Abstract

Background

Linezolid is classed as oxazolidinone antibiotics which can be used to treat severe infections caused by vancomycin-resistant Enterococcus faecium, hospital-acquired pneumonia caused by Staphylococcus aureus, complicated skin, and uncomplicated skin structure infections (SSSIs) caused by methicillin-susceptible S. aureus or Streptococcus pyogenes, and community-acquired pneumonia caused by Streptococcus pneumoniae. However, many studies have suggested it can also cause thrombocytopenia and pancytopenia.

Patients and Methods

We report on three patients with linezolid-pancytopenia. Patients in cases 1 and 2 were diagnosed with heart failure with preserved ejection fraction (HFpEF) and were both administered with dapagliflozin, one of the sodium-dependent glucose transporters 2 inhibitors (SHLT-2i).

Results

Two patients were diagnosed with type 2 diabetes, pneumonia, and hyponatremia. Severe myelosuppression occurred in both patients, with a severe decrease in leukocytes and platelets and a moderate decrease in hemoglobin, who eventually passed away despite the discontinuation of linezolid and adopting appropriate treatment measures. The patient in case 3 was diagnosed with pneumonia, type 2 diabetes, and sequelae of cerebral thrombosis. After twelve days of treatment, the patient developed moderate thrombocytopenia and anemia. She recovered without any additional treatment after the discontinuation of linezolid.

Conclusion

In this case series, two patients with irreversible myelosuppression were treated with both linezolid and SGLT-2i, and one diabetic patient with single linezolid use presented with reversible pancytopenia, suggesting that SGLT-2i may exacerbate myelosuppression of linezolid. Linezolid should be used with caution in infectious patients with a history of SGLT-2i. We will conduct relevant animal experiments to clarify the interaction between the two drugs.

Keywords:

• linezolid
• pancytopenia
• SGLT-2 inhibitor
• HFpEF

Ethics and Dissemination

Informed written consent was obtained from three patients’ children for the publication of this report. Patient in case 3 was diagnosed with sequelae of cerebral thrombosis, for which she had trouble communicating. Therefore, a informed consent was obtained from the patient’s child. The case series was approved to publish by Qingdao Central Hospital.

Acknowledgment

We also thank Dr Meili Zhou and Dr Ling Song for their contribution to case 3 in this case series.

Author Contributions

Mengmei Li, Yujin Li, and Jun Teng were the patients’ attending physicians, reviewed the literature, and contributed to manuscript drafting; Wencheng Shen designed the case seies and critically reviewed the manuscript. All authors contributed to data analysis, drafting or revising the article, have agreed on the journal to which the article will be submitted, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.

Disclosure

None of the authors has a conflict of interest to declare in this article.