Acute Onset Lactic Acidosis Secondary to Linezolid.

Linezolid has been the mainstay of treatment for multidrug-resistant Gram-positive bacteria. Common adverse effects with linezolid include diarrhea, nausea, headache, and bone marrow suppression. A less common and understudied side effect is lactic acidosis. This study describes a 19-year-old man with linezolid-induced lactic acidosis (LILA). The patient was admitted for the management of acute decompensated systolic heart failure, which improved on guideline-directed medication therapy (GDMT). During hospitalization, he developed an erythematous weeping cellulitis infection of his right lower extremity and was started on linezolid 600 mg every 12 hours with wound and blood cultures collected. After one day of treatment with linezolid, lactic acid levels acutely increased from 1.8 mmol/L to 5 mmol/L without any other interventions. Suspecting possible LILA, linezolid was transitioned to cephalexin with a reduction of lactic acid to 2.4 mmol/L, one day following linezolid cessation. After two days of linezolid cessation, lactic acid levels decreased to 1.9 mmol/L. Lactic acidosis can have profound hemodynamic consequences for patients, including death. A meta-analysis study of 35 articles with 47 patients (28 males, 18 females, and one non-binary) was done, which found a 25.5% mortality rate associated with LILA. Due to this high mortality, having a greater understanding of the associated risk factors with LILA is very important. This case study aims to inform clinicians of the potential harmful side effects associated with linezolid, as well as the understudied risk factors involved in LILA that are needed to prevent its occurrence.

Evaluating the Safety of Ultra-Low-Dose Estrogen Contraception in Sickle Cell Trait With Focus on Cerebral Venous Sinus Thrombosis.

Ultra-low-dose combination estrogen-progestin contraceptive pills (OCP) have been marketed as being safer to use than previously higher estrogen-containing OCPs. While multiple large studies have shown a dose-dependent association between estrogen and deep vein thrombosis, there remains sparse guidance or data as to whether patients with sickle cell trait should avoid estrogen-containing OCPs regardless of the dosage. We present a case of a 22-year-old female with a history of sickle cell trait who had recently been started on an ultra-low-dose norethindrone-ethinyl estradiol-iron (1-20 mcg) that presented with headache, nausea, vomiting, and obtunded. Initial neuroimaging was significant for an extensive superior sagittal sinus thrombosis with extension into the confluence of dural venous sinuses, right transverse sinus, right sigmoid sinus, and right internal jugular vein which ultimately required systemic anti-coagulation. Her symptoms largely resolved within four days after starting anti-coagulation. She was discharged on day six to complete a six-month course of oral anti-coagulation. At her neurology follow-up three months later, the patient reported resolution of all symptoms. This study evaluates the safety of ultra-low-dose estrogen-containing contraceptive pills in the sickle cell trait population with special focus on cerebral sinus thrombosis.