Linezolid induced acute toxic leukoencephalopathy and severe thrombocytopenia presenting as stroke mimic—a case report

A 67-year-old lady was admitted with, right sided weakness and right arm shaking. She had recently completed a course of Linezolid for a diabetic foot infection and osteomyelitis. Prior to this she had prodromal symptoms including lethargy and loss of appetite. Clinical features prompting presentation included global weakness, verbal dysfluency and visual disturbance. MRI brain showed bilateral alteration of signal in the deep white matter of the posterior frontal and parietal lobes, sparing the superficial cortical areas. These areas showed diffusion restriction, suggestive of, but not limited to, ischaemic stroke. During admission she had a decline in consciousness and was hypertensive. An acute drop in haemoglobin and platelets occurred prompting consideration of Thrombotic Microangiopathy and other drug related/malignant/infective aetiologies. A diagnosis of Linezolid induced Acute Toxic Leukoencephalopathy and thrombocytopenia was made based on clinico-radiographic features and exclusion of other causes.