Kidney Week

Abstract: PUB237

Crazy About You: Linezolid-Induced Toxic Encephalopathy in a Recent Kidney Transplant

Session Information

• Publication Only

Category: Transplantation

• 2002 Transplantation: Clinical

Authors

• Rodriguez Rivera, Carolina Isabel, Methodist Health System, Dallas, Texas, United States

Carolina Isabel Rodriguez Rivera, MD

• Goycochea, Carlos J., Methodist Health System, Dallas, Texas, United States

Carlos J. Goycochea, MD

• Sudheer, Namitha, Methodist Health System, Dallas, Texas, United States

Namitha Sudheer, MD

• Castillo-Lugo, Jose A., Dallas Nephrology Associates, Dallas, Texas, United States

Jose A. Castillo-Lugo, MD

• Sebastian, Lisa M., Dallas Nephrology Associates, Dallas, Texas, United States

Lisa M. Sebastian, MD, FASN

Introduction

Linezolid is an antibiotic that inhibits bacterial protein synthesis, preventing bacterial growth and is effective in targeting gram-positive infections. Linezolid-induced encephalopathy is a rare and serious side effect that can present as altered mental status, lactic acidosis, peripheral neuropathy, and myopathy. Risk factors that contribute to this side effect are neurological conditions, alcohol-use disorder, and significant hepatic or renal impairment. This is a case of a kidney transplant recipient who developed linezolid-induced encephalopathy during treatment for pulmonary nocardiosis.

Case Description

This is a case of a 65 year old male patient who underwent DDKT. Three months post transplantation, the patient developed sepsis due to pulmonary nocardiosis without CNS involvement and acute kidney injury and was started on Linezolid. After 48 hours of treatment, he developed altered mental status, confusion, and slurred speech. Head CT without contrast, CTA, MRI were negative for acute cerebrovascular accidents. EEG showed severe diffuse encephalopathy. Linezolid was discontinued. The patient was started on CRRT to facilitate medication clearance. Neurological symptoms resolved within 2 days.

Discussion

Linezolid-associated encephalopathy is a rare side effect which can present hours after administering the medication. This case highlights the importance of clinical suspicion for medication-induced toxicity in recent kidney transplant patients, particularly those with mild to moderate renal impairment.