J Korean Ophthalmol Soc.  2019 Dec;60(12):1363-1368. 10.3341/jkos.2019.60.12.1363.

Optic Neuropathy after Taking Linezolid

• Yoon YS
• Lee CK

• KMID: 2466197
• DOI: http://doi.org/10.3341/jkos.2019.60.12.1363

Abstract

PURPOSE
We report a case of optic neuropathy in a patient who was treated with pre-extensively drug-resistant tuberculosis(pre-XDR TB) treatment with linezolid.
CASE SUMMARY
A 61-year-old male patient with no other underlying disease was diagnosed with pre-XDR Tb 6 months before and took the TB drug at another hospital. Ethambolol was not prescribed because it was resistant from the beginning of TB treatment. Threrefore, linezolid was included for treatment of pre-XDR TB. The patient's best corrected visual acuity was 20/400 in both eyes at the time of outpatient visit. In Ishihara color vision test, both eyes showed complete color blindness. There was no detectable relative afferent pupillary defect, and fundus examination showed hyperemic optic discs and visual field examination showed both central visual field defects. Linezolid induced optic neuropathy was suspected, the drug was discontinued. After one month, the patient's best corrected visual acuity recovered to 20/20 in both eyes, and visual field and color vision returned to normal at 3 months.
CONCLUSIONS
Linezolid is a broad spectrum antibiotic and is a useful drug for the treatment of broad-spectrum tuberculosis. However, since long-term use may cause optic neuropathy, the possibility of optic neuropathy should always be considered. If optic neuropathy is suspected, prompt drug withdrawal is required and reversible clinical changes can be expected.

Keyword

Linezolid induced optic neuropathy; Tuberculosis

MeSH Terms

Color Vision
Color Vision Defects
Humans
Linezolid*
Male
Middle Aged
Optic Nerve Diseases*
Outpatients
Pupil Disorders
Tuberculosis
Visual Acuity
Visual Fields
Linezolid

Figure

• 

  Figure 1 Initial FP, VF, and OCT findings. (A) FP shows slightly hyperemic disc on both eyes. (B) VF shows both central scotomaand left eye scomta is bigger than right eye. (C) OCT shows edematous RNFL on both eyes. FP = fundus photo; VF = visual field;OCT = optical coherence tomography; RNFL = retinal nerve fiber layer; S = superior; N = nasal; I = inferior; T = temporal.

• 

  Figure 2 Initial macular OCT findings and initial VEP test. Arrows (A, B) show normal ellipsoid zone on both eyes. (C) PatternVEP test shows slightly decreased P100 amplitude on both eyes. OCT = optical coherence tomography; VEP = visual evokedpotential.

• 

  Figure 3 Follow up of FP, VF, and OCT. Three months later after treatment, (A) FP and (B) VF show normalized fundus and visualfield on both eyes. (C) OCT shows RNFL swelling is reduced to normal range on both eyes. FP = fundus photo; VF = visual field;OCT = optical coherence tomography; RNFL = retinal nerve fiber layer; S = superior; N = nasal; I = inferior; T = temporal.

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  Figure 4 Compare with Initial GCL complex and 3 months later GCL complex. Initial (A) and 3 months later after treatment, GCLOCT (B). GCL layer on macular area were changed as more thinner than before stopping linezolid. GCL = ganglion cell layer; OCT= optical coherence tomography.

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