Linezolid-Associated Triad of Acute Pancreatitis, Lactic Acidosis, and Hypoglycemia: A Rare Case Report and Literature Review.

BACKGROUND Linezolid is a widely used antibiotic with excellent oral bioavailability and broad-spectrum activity against resistant gram-positive organisms. However, its mitochondrial toxicity can result in serious adverse effects. We present a rare case of a triad of acute pancreatitis, lactic acidosis, and hypoglycemia associated with prolonged linezolid use - an underrecognized complication that can be life-threatening if not promptly identified. CASE REPORT A 59-year-old woman with end-stage renal disease on regular hemodialysis was treated with oral linezolid for a pulmonary infection complicated by a loculated pleural effusion. Three weeks into therapy, she presented to the emergency department with severe epigastric pain, nausea, and vomiting. Laboratory investigations revealed marked hyperlipasemia, high anion gap metabolic acidosis with elevated lactate levels, and relative hypoglycemia. Imaging and further laboratory workup ruled out other common causes of pancreatitis, including gallstones, alcohol use, hypertriglyceridemia, and drug interactions. In the absence of an alternative explanation, linezolid-induced mitochondrial toxicity was suspected as the underlying cause. The antibiotic was discontinued immediately. The patient showed rapid clinical and biochemical improvement with supportive management, including intravenous fluids and correction of metabolic derangements. CONCLUSIONS This case underscores the need for vigilance when prescribing linezolid, especially in patients with renal impairment, who are at higher risk of drug accumulation and toxicity. Clinicians should suspect linezolid-induced toxicity in patients presenting with new or unexplained gastrointestinal or metabolic symptoms during treatment. Early recognition and prompt discontinuation are necessary.