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-fiber painful neuropathy (visual analogue scale, VAS = 82 on 0-100 scale) with marked skin denervation in the leg (epidermal nerve density, END = 2.32 fibers/mm, norm < 5.88 fibers/mm) and significant elevation of warm threshold in the foot (40.0 ¢XC, norm < 39.4 ¢XC) after the use of linezolid for six months. Eight months after the discontinuation of linezolid, the skin became fully reinnervated (END = 9.04 fibers/mm) with disappearance of neuropathic pain (VAS = 0) and normalization of the warm threshold (36.3 ¢XC). Nerve conduction studies for large-diameter motor and sensory nerves were normal. This report documents a pure small-fiber sensory neuropathy after prolonged use of linezolid, and the relation between skin innervation and corresponding neuropathic pain.
- skin biopsy
- small-fiber neuropathy