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Case Reports
. 2022 Sep 19:15:5509-5517.
doi: 10.2147/IDR.S375694. eCollection 2022.

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

Meng Mei Li  1 , Wen Cheng Shen  2 , Yu Jin Li  1 , Jun Teng  1
Affiliations
Case Reports

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

Meng Mei Li et al. Infect Drug Resist. .

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: HFpEF; SGLT-2 inhibitor; linezolid; pancytopenia.

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Conflict of interest statement

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

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