利奈唑胺致血小板减少和贫血

1例55岁男性患者因糖尿病高渗性昏迷、重症肺炎联合应用亚胺培南西司他丁钠1.0 g、3次/d及左氧氟沙星0.5 g、1次/d静脉滴注。由于效果不佳,加用利奈唑胺0.6 g,2次/d静脉滴注,患者体温逐渐下降。入院时患者红细胞计数4.4×1012/L,血红蛋白141 g/L,血小板计数251×109/L。利奈唑胺治疗第1天红细胞3.7×1012/L,血红蛋白122 g/L,血小板计数88×109/L;第5天血小板计数降至34×109/L。立即停用利奈唑胺,改为替考拉宁,亚胺培南西司他丁钠和左氧氟沙星继续应用,并输注新鲜血浆200 ml。停用利奈唑胺第6天血小板计数恢复正常(192×109/L),但红细胞和血红蛋白水平进行性下降,停药第8天降至最低,分别为2.2×1012/L、69 g/L。之后逐渐上升,于停药第27天接近正常水平。

Thrombocytopenia and anemia induced by linezolid

A 55-year-old man with diabetic hyperosmolar coma and severe pneumonia received combination therapy with an IV infusion of imipenem and cilastatin sodium 1.0 g three times daily and levofloxacin 0.5 g once daily.An IV infusion of linezolid 0.6 g twice daily was added to his regimen due to poor efficacy,and then his temperature dropped gradually.On admission,his red blood cell count,hemoglobin level,and platelet count were respectively 4.4×1012/L,141 g/L,and 251×109/L and,on the first day of linezolid therapy,were 3.7×1012/L,122 g/L,88×109/L,respectively.On the fifth day,his platelet count decreased to 34×109/L.Linezolid was discontinued immediately and changed to teicoplanin.Imipenem and cilastatin sodium and levofloxacin were continued and fresh blood plasma 200 ml was administered.On the sixth day after linezolid discontinuation,the platelet count returned to normal range(192×109/L).However,the red blood cell count and hemoglobin level fell progressively and,on the eighth day,reaching minimum values of 2.2×1012/L and 69 g/L,respectively.Then the two values increased gradually and,on day 27 after drug discontinuation,approached normal range.