Linezolid-induced thrombocytopenia in a child with a liver transplant: A case report.

OBJECTIVE Linezolid-induced thrombocytopenia is rarely reported in liver transplant patients, especially in children. CASE SUMMARY We report a case of a 7-month-old liver-transplanted child who suffered from thrombocytopenia induced by linezolid. We simulated the pharmacokinetics of linezolid in a healthy adult using the physiologically based pharmacokinetic (PBPK) model and found that the liver is the most abundant organ for the distribution of linezolid. PRACTICE IMPLICATIONS Linezolid has a high distribution in the liver. As a result, an increased awareness about the risk of linezolid-induced thrombocytopenia should be strengthened in patients with liver injury. Effects of ethnicity: The differences between Chinese patients and patients of other ethnicities may lead to the diverse effects of linezolid in different patients. The influence of body weight (BW) difference in pharmacokinetics (PK) of linezolid between Asian (Chinese and Japanese) and Caucasians was demonstrated in several population PK studies [1, 2, 3]. The average BW of Asians is lower than that of the Caucasian population, the clearance and apparent volume of distribution are lower than in the European population, and Cmax is higher than in the Western population. Therefore, the adverse effects of linezolid at the same dose may increase in Chinese patients.