We report the case of a 75-year-old man with
acute myeloid leukemia who developed
hyponatremia after
linezolid administration. Because induction
therapy did not achieve complete remission for this man, we initiated re-induction
therapy with enocitabin and
daunomycin. Seven days after
chemotherapy, the patient experienced a
catheter-related blood stream
infection (CRBSI) due to methicilin resistant staphylococcus aureus (MRSA). When treatment with albekacin and
fosfomycin was in effective,
linezolid was administrated intravenously and he became afebrile. On day 8 after
linezolid administration, however, he reported general
fatigue and slight consciousness disturbance. His serum
sodium concentration was 119 mEq/L and his urinary
sodium excretion rose to 143 mEq/day, although intravenous
sodium intake was 98 mEq/day. Because of the sufficiency of urine volume and
weight loss, we surmise that inappropriate ADH secretion (
SIADH) syndrome was unlikely. We diagnosed renal
salt wasting syndrome (RSWS) based on calculation of the amount of
sodium intake and the amount of
sodium excreted from the kidneys. After
linezolid was discontinued and aggressive treatment with
sodium supplement begun, his consciousness cleared as his low serum
sodium level rose. This is, to the best of our knowledge, the first case reported on the development of RSWS after
linezolid treatment. Although the process remains unclear, our case suggests that
linezolid may induce RSWS after intensive
chemotherapy.