Linezolid-induced status epilepticus

A 51-year-old man with a recent history of lung adenocarninoma (stage T2M0) with left hilar and mediastinal adenopathy initially treated by cisplatin-navelbine chemotherapy and changed for (due to occurrence of left iliac bone metastasis) ongoing atezolizumab immunotherapy (started 10 days earlier), presented with fever and dysuria since 6 days. Urine culture was positive for Enterococcus faecium. Antibiotic treatment with oral linezolid 600 mg bid was started. 1 day after the start of linezolid treatment, the patient presented with generalized tonic–clonic status epilepticus followed by diffuse maculopapular skin rash 2 h later. The patient had no history of seizures. Antiepileptic treatment was started with an intravenous lacosamide loading dose of 200 mg followed by 100 mg bid. Tonic–clonic contractions disappeared and the patient progressively regained consciousness. Laboratory findings showed thrombocytopenia (70,000/mm³) and leukopenia (2920/mm³) (platelet and white blood cell count were strictly normal 4 days earlier). Electroencephalogram (not available on the day of admission) performed 1 day later showed absence of epileptic discharges. Gadolinium-injected MRI was strictly normal. CSF analysis showed slightly elevated white blood count (9/mm³) and highly increased protein level (2.55 g/L). Oligoclonal bands were absent. CSF bacterial cultures, viral serologies were negative, and anti-Hu/Yo/Ri/amphiphysin/Ma1-2/CV2/SOX1/GAD/LGI1/CASPR2/NMDA antibodies were all negative. Clinical examination was unremarkable 36 h after admission. In total, four lumbar punctures were performed, with cytopathological examination showing absence of malignant cells. White cell count normalized and protein levels decreased progressively on consecutive CSF analyses. …