ABSTRACT Purpose: To report a rare toxic optic neuropathy after long-term use of two medications: ethambutol and linezolid. Case report: A 65-year-old man presented to the Miami Veterans Affairs Medical Center in December 2014 for evaluation of progressive vision decrease in both eyes. The patient presented with best-corrected visual acuities of 20/400 in the right eye and counting fingers at 5 feet in the left eye. Color vision was significantly reduced in both eyes. Visual fields revealed a cecocentral defect in both eyes. His fundus and optic nerve examination was unremarkable. Because vision continued to decline after discontinuation of ethambutol, linezolid was also discontinued, after which vision, color vision, and visual fields improved. Because of these findings, the final diagnosis was toxic optic neuropathy. Final visual outcome was 20/30 in the right eye and 20/40 in the left eye. Conclusions: Drug-associated toxic optic neuropathy is a rare but vision-threatening condition. Diagnosis is made based on an extensive case history and careful clinical examination. The examination findings include varying decrease in vision, normal pupils and extraocular muscles, and unremarkable fundoscopy, with the possibility of swollen optic discs in the acute stage of the optic neuropathy. Other important findings descriptive of toxic optic neuropathy include decreased color vision and cecocentral visual field defects. This case illustrates the importance of knowledge of all medications and/or substances a patient consumes that may cause a toxic reaction and discontinuing them immediately if the visual functions are worsening or not improving.
AGRAWALR,ADDISONP,SAIHANZ,et al.Optic neu-ropathy secondary to Linezolid for multidrug-resistant mycobacterial spinal tuberculosis[J].,2015,23(1):90-92.
To report a case of optic neuropathy secondary to Linezolid, second line anti tuberculosis agent.22 year Indian male with multidrug resistant spinal tuberculosis and TB meningitis was started on second line anti tuberculosis drugs. Within one month of onset of second line anti TB drug, he was noted to have optic neuropathy in both eyes. Visual field and electro diagnostics suggested optic neuropathy.Linezolid is a synthetic oxazolidinone broad spectrum antibiotic and has been in off label use for multidrug resistant tuberculosis (MDR-TB). There are very scattered case reports of optic neuropathy secondary to use of this off label drug. In our case, the optic neuropathy was however reversible on stoppage of the drug.It seems prudent that baseline ophthalmological evaluation to be done for all patients to be subjected for treatment with this drug for any short term or long term therapy.
NAMBIARS,RELLOSAN,WASSEL RT,et al.Linezolid-associated peripheral and optic neuropathy in children[J].,2011,127(6):1528-1532.
Abstract OBJECTIVE: Peripheral neuropathy (PN) and optic neuropathy (ON) associated with linezolid use are described in the adult literature; however limited information is available in pediatrics. The purpose of this communication is to summarize pediatric cases of linezolid-associated neuropathy and to increase awareness of these neurologic side effects so that clinicians can most appropriately balance the benefits and risks of linezolid in the pediatric population. METHODS: A search of the FDA Adverse Events Reporting System was performed for all pediatric cases of neuropathy from April 2000-2009. AERS includes both inpatient and outpatient data. Inpatient utilization patterns for linezolid were also assessed from January 2000 to December 2008. RESULTS: Eight pediatric cases of linezolid-associated neuropathy were identified. Treatment duration ranged from 4 weeks to 1 year. Five patients had PN alone, one had only ON and two had both. Symptoms of PN included pain, numbness, weakness, and paresthesias. Symptoms of ON included decreased visual acuity and color vision. Three children had other adverse events associated with linezolid including acidosis, anemia, and leukopenia. Outcomes were reported in 5 cases. Resolution of symptoms occurred between 2 weeks and 6 months after discontinuation of linezolid. Utilization data showed that during the study period, overall inpatient utilization of linezolid had increased. CONCLUSIONS: While linezolid may be used to treat serious infections often needing extended courses of therapy, potential safety concerns should be kept in mind. In the circumstance of prolonged use of linezolid in children, it is likely that more cases of neuropathy may occur.
KIUCHIK,MIYASHIROM,KITAGAWAC,et al.Linezo-lid-associated optic neuropathy in a patient with ocular sarcoidosis[J].,2009,53(4):420-424.
We describe a case of bilateral linezolid-associated optic neuropathy in a patient with ocular sarcoidosis.A 70-year-old woman with sarcoidosis noted foggy vision in both eyes. Best-corrected visual acuity was 0.5 in the right eye and 0.9 in the left. No abnormality other than slight optic disc hyperemia was visible in either eye. A central scotoma in both eyes and enlargement of the blind spot in the right eye were detected by Goldmann perimetry examination, and magnetic resonance imaging demonstrated an edematous optic nerve in the right eye. Therefore, retrobulbar optic neuritis resulting from sarcoidosis was initially suspected. Sub-Tenon's capsule injection of triamcinolone acetonide along with steroid pulse therapy was given; however, best-corrected visual acuity worsened to 0.06 in the right eye and 0.08 in the left. Pulse therapy was discontinued on day 1, and the possibility of linezolid-associated optic neuropathy was speculated because linezolid had been given for methicillin-resistant Staphylococcus aureus osteomyelitis 2 years before by an orthopedist. After discontinuation of linezolid, best-corrected visual acuity improved to 0.8 in the right eye and 0.9 in the left, and the optic disc hyperemia in both eyes disappeared.Our findings demonstrate that it is important for ophthalmologists as well as physicians and orthopedists to consider the possibility of optic neuropathy caused by long-term use of linezolid.
JOSHIL,TAYLOR SR,LARGEO,et al.A case of optic neuropathy after short-term linezolid use in a patient with acute lymphocytic leukemia[J].,2009,48(7):e73-74.
Abstract A patient undergoing chemotherapy for treatment of acute lymphocytic leukemia developed septicemia that was treated with linezolid for 16 days. The patient subsequently reported reduced vision in both eyes and was found to have bilateral optic neuropathy. After the discontinuation of linezolid treatment, both the optic neuropathy and visual impairment resolved without sequelae.
JAVAHERIM,KHURANA RN, O'HEARN T M, et al. Li-nezolid-induced optic neuropathy:a mitochondrial disorder?[J].,2007,91(1):111-115.
We report a case of bilateral mitochondrial optic neuropathies secondary to long-term linezolid treatment, show the nature of recovery, review the findings in the literature and propose a potential mitochondrial mechanism for linezolid-induced mitochondrial optic neuropathy. This is an observational case report and literature review with presentation of the clinical course of linezolid mitochondrial optic neuropathies through clinical and psychophysical documentation. Main outcome measures included: visual acuity, funduscopical examinations and peripapillary retinal nerve fibre layer (PRNFL) optical coherence tomography (OCT). A 6-year-old boy presented with bilateral optic neuropathies secondary to 1 year of linezolid treatment for osteomyelitis of the mandible. On presentation, visual acuities were 20/400 in both eyes, with considerable optic disc oedema, hyperaemia and PRNFL swelling confirmed by OCT. 2 weeks after the discontinuation of linezolid, visual acuities returned to 20/25 in both eyes, with reduction in the optic disc oedema, hyperaemia and PRNFL swelling. 3 months after the discontinuation of linezolid treatment, visual acuities were stable at 20/20 in both eyes, with a marked decrease in PRNFL swelling confirmed by OCT, and the development of mild temporal optic disc pallor in both eyes. Doctors should be aware of impairments of vision among patients on long-term linezolid treatment and promptly discontinue treatment to prevent irreversible vision loss. The development and resolution of bilateral optic neuropathies with considerable PRNFL swelling in this patient provide insight into the more general rubric of mitochondrial optic neuropathies.
LEEE,BURGERS,SHAHJ,et al.Linezolid-associated toxic optic neuropathy:a report of 2 cases[J].,2003,37(10):1389-1391.
We describe 2 cases in which the prolonged use of linezolid to treat complicated methicillin-resistant Staphylococcus aureus infections was followed by acutely developed blurred vision and progressive loss of vision and color perception during the ensuing few weeks. Both patients received a diagnosis of toxic optic neuropathy, and linezolid therapy was stopped. The patients experienced an initial rapid partial improvement and a subsequent gradual, almost complete, recovery over many months.