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Painful neuropathy with skin denervation after prolonged use of linezolid
  1. C-C Chao1,
  2. H-Y Sun2,
  3. Y-C Chang1,
  4. S-T Hsieh1,3
  1. 1
    Department of Neurology, National Taiwan University Hospital, Taipei 10002, Taiwan
  2. 2
    Department of Internal Medicine, National Taiwan University Hospital, Taipei 10002, Taiwan
  3. 3
    Department of Anatomy and Cell Biology, National Taiwan University College of Medicine, Taipei 10051, Taiwan
  1. Dr Sung-Tsang Hsieh, Department of Neurology, National Taiwan University Hospital, 7 Chung-Shan S. Road, Taipei 10002, Taiwan; shsieh{at}ntu.edu.tw

Abstract

The prolonged use of linezolid, a new antibiotic against drug-resistant Gram-positive pathogens, might cause painful neuropathy. This finding raises the possibility that small-diameter sensory nerves in the skin, which are responsible for transmitting nociceptive information, might be affected. We report a 53-year-old female who developed pure small-fibre painful neuropathy (visual analogue scale, VAS = 82 on 0–100 scale) with marked skin denervation in the leg (epidermal nerve density, END = 2.32 fibres/mm, norm <5.88 fibres/mm) and significant elevation of the warm threshold in the foot (40.0°C, norm <39.4°C) after the use of linezolid for 6 months. Eight months after the discontinuation of linezolid, the skin became fully reinnervated (END = 9.04 fibres/mm), with disappearance of neuropathic pain (VAS = 0) and normalisation of the warm threshold (36.3°C). Nerve conduction studies for large-diameter motor and sensory nerves were normal. This report documents a pure small-fibre sensory neuropathy after prolonged use of linezolid, and the relationship between skin innervation and corresponding neuropathic pain.

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Footnotes

  • Competing interests: None.

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