REMARKABLE OUTCOME AFTER MANAGEMENT OF LINEZOLID INDUCED OPTIC NEUROPATHY ON MULTI DRUG RESISTANT TUBERCULOSIS PATIENT:A CASE REPORT

Background:Toxic optic neuropathy (TON) is a group of medical disorders which can be defined by visual impairment due to optic nerve damage by a toxin. Long term of linezolid treatment as one of antituberculosis therapy (ATT) can trigger Linezolid induced toxic optic neuropathy (LION). It is characterized by papillomacular bundle
damage, cecocentral scotoma, and reduced of color vision.
Case Illustration: A 48 years old woman reffered from Pulmonology department complained blurred vison of both eyes since 7 days before. The patient has been diagnosed with MDR-TB since May 2022 and has been consuming ATT for 8 months. One of the ATT regimen were Linezolid 450mg once a day. BCVA of both eyes were 3/60 and 2/60 . Ishihara in right eye were 4/38, and 2/38. Funduscopy examination revealed bilateral optic disc edema with increasing of RNFL thickness in both eyes in OCT and bilateral central scotoma in HFA. The patient was diagnosed with linezolid induced optic neuropathy and replaced linezolid with another ATT. After 6 months of follow-up, BCVA in the both eyes became 5/5 with improving of color vision became 35/38 in both eyes. OCT and HFA examination revealed no thickening of RNFL thickness and no visual field defect.
LION is a complication associated with prolonged use of linezolid, regardless of the dose received, and reversible in most cases but the exact duration of symptom resolution following drug discontinuation remain unknow. However, the presence of other illnesses can impede the recovery.
Conclusion: Monitoring of visual function is important in patients on long-term linezolid therapy for early recognition of toxicity and discontinuation of the drug resulting in complete visual recovery.