Neonatal Cardiac and Respiratory Arrest During Linezolid Therapy: A Case Report

Lactic acidosis is one of the severe adverse reactions of linezolid. Its clinical manifestations are non-specific, primarily including abdominal discomfort, nausea, vomiting, diarrhea, weakness, lethargy, rapid breathing, and tachycardia, with no reports of cardiac and respiratory arrest. In this case report, we present a 13-day-old male infant with omphalitis caused by methicillin-resistant Staphylococcus aureus (MRSA) infection, who was treated with linezolid. He had lactic acidosis before treatment, which was not severe and was likely related to the infection. After linezolid therapy, he experienced cardiac and respiratory arrest, and re-measurement showed an increase in lactate levels. After resuscitation, linezolid withdrawal, and symptomatic treatment, lactate levels decreased. However, due to hypoxic-ischemic encephalopathy and uncorrectable ventricular arrhythmia caused by post-cardiopulmonary resuscitation myocardial damage, the infant died. A comprehensive autopsy and genetic testing were performed after death, and no congenital diseases or inherited metabolic diseases were found. Given that this case was a sudden infant death without typical symptoms of lactic acidosis and linezolid is often mistakenly considered safer than vancomycin in the treatment of special populations, this paper analyzes and discusses this to draw attention to clinical treatment. More research is needed in the future to fully demonstrate its causal relationship and mechanism of action.