Linezolid Associated Asymptomatic Hypoglycemia in a Patient with Advanced Gynecologic Cancer: A Case Report and Literature Review

Hypoglycemia is a rare but documented adverse effect of linezolid. We report a 72-year-old patient with late-stage gynecologic cancer and abdominal MRSA peritonitis, who developed persistent asymptomatic hypoglycemia after starting linezolid. The patient had type 2 diabetes on metformin-glibenclamide. Fasting blood glucose dropped to 2.08 mmol/L (reference: 3.9-6.1 mmol/L) 1 day post-linezolid initiation; hypoglycemia persisted despite stopping oral hypoglycemics and administering dextrose, but normalized within 24 hours after linezolid discontinuation (replaced with tigecycline). Naranjo ADR Scale scoring (7 points) confirmed a "probable" causal link. We present dynamic glucose trends (reinforcing causality) and review linezolid-associated hypoglycemia literature. This case highlights the need for glucose monitoring in linezolid-treated patients, especially at high risks, even without diabetes or symptoms.