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This case describes an 87-year-old woman with multiple comorbidities who underwent four hospitalizations within six months for recurrent cellulitis, staying afebrile and without leukocytosis despite visible inflammation. Elevated inflammatory biomarkers persisted, and wound cultures were polymicrobial. Extended linezolid therapy led to lactic acidosis during the final admission, consistent with mitochondrial toxicity, and the patient died two days after discharge.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/afebrile-recurrent-cellulitis-complicated-by-linezolid-induced-lactic-acidosis-in-an-elderly-patient/452342/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/afebrile-recurrent-cellulitis-complicated-by-linezolid-induced-lactic-acidosis-in-an-elderly-patient/452342.png","ImageObject",300,407,{"name":92,"@type":93},"SANS","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-05","2026-09-30",true,{"@type":102,"interactionType":103,"userInteractionCount":34},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"Why was cellulitis difficult to diagnose in this elderly patient?","Question",{"text":112,"@type":113},"The patient remained afebrile and without leukocytosis, reflecting an age-related blunted inflammatory response (immunosenescence) that can delay recognition and complicate care.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What organisms were found in the wound cultures?",{"text":117,"@type":113},"Wound cultures revealed polymicrobial organisms, including Pseudomonas aeruginosa, Klebsiella pneumoniae, and Stenotrophomonas maltophilia.",{"name":119,"@type":110,"acceptedAnswer":120},"How was linezolid-associated lactic acidosis identified?",{"text":121,"@type":113},"During the final hospitalization, the patient developed lactic acidosis with elevated lactate levels in the absence of shock or hypoxemia, suggesting linezolid-induced mitochondrial toxicity after prolonged therapy.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},452342,1792218748,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":34,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":24,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":144,"preview_page_count":4},962090760505,"https://ap-avatar.wpscdn.com/davatar_155a257f0dc6eb9ab79c44ca47cae57d","e-ISSN 1941-5923  \n© Am J Case Rep, 2025; 26: e951194 DOI: 10. 12659/AJCR.951194  \nReceived: 2025.08.19  \nAccepted: 2025.11.03  \nAvailable online: 2025.11.17  \nPublished: 2025.12.22  \nAuthors’ Contribution: Study Design A  \nData Collection B Statistical Analysis C Data Interpretation D Manuscript Preparation E Literature Search F Funds Collection G  \nBCDEF 1 BE 1,2  \nCorresponding Author: Financial support: Conflict of interest:  \nAfebrile Recurrent Cellulitis Complicated by Linezolid-Induced Lactic Acidosis in an Elderly Patient  \nYanizbeth Yambó-Chévere Rafael Bermúdez-Rivera  \n1 Department of Medicine, Ponce Health Sciences University, Ponce, Puerto Rico  \n2 Department of Internal Medicine, Ashford Presbyterian Community Hospital, San Juan, Puerto Rico  \nYanizbeth Yambó-Chévere, e-mail: [yyambo22@stu.psm.edu](yyambo22@stu.psm.edu)[ ](yyambo22@stu.psm.edu)None declared  \nNone declared  \nPatient: Female, 87-year-old  \nFinal Diagnosis: Lactic acidosis • recurrent cellulitis  \nSymptoms: Fatigue • lower extremity swelling • recurrent skin redness without fever  \nClinical Procedure: —  \nSpecialty: Geriatrics • General and Internal Medicine  \nObjective: Unusual or unexpected effect of treatment  \nBackground: Cellulitis typically presents with erythema, swelling, warmth, and systemic signs such as fever and leukocytosis. In older adults, immunosenescence and multimorbidity can blunt classical inflammatory responses, delaying diagnosis and complicating care. Linezolid, while effective against resistant gram-positive organisms, carries a risk of mitochondrial dysfunction and lactic acidosis during prolonged therapy.  \nCase Report: We describe the case of an 87-year-old Puerto Rican woman with multiple comorbidities who experienced 4 hospitalizations in 6 months for recurrent cellulitis. Despite having visible inflammation, she consistently remained afebrile and without leukocytosis. Laboratory findings demonstrated a persistently elevated C-reactive protein level and erythrocyte sedimentation rate. Wound cultures revealed polymicrobial organisms, including Pseudomonas aeruginosa, Klebsiella pneumoniae, and Stenotrophomonas maltophilia. Broad-spectrum antibiotics were used, including linezolid at 600 mg twice daily, with an estimated total exposure of approximately  \n8 weeks across hospitalizations and outpatient treatment. Renal and hepatic function were monitored and remained stable throughout. Ultrasound imaging did not reveal abscess or osteomyelitis. During the final hospitalization, she developed lactic acidosis (lactate 2.5-3.1 mmol/L), in the absence of shock or hypoxemia, suggesting linezolid-induced mitochondrial toxicity. The patient died 2 days after discharge.  \nConclusions: This case underscores the diagnostic challenges of afebrile cellulitis in frail older adults and the importance of careful antimicrobial stewardship. Clinicians should maintain vigilance for linezolid-induced lactic acidosis during extended therapy, particularly in patients with atypical presentations. The integration of biomarker trends into decision-making, prioritization of preventive strategies, and coordination of geriatric care are essential to improve outcomes in this vulnerable population.  \nKeywords: Age Factors • Cellulitis • Immunosenescence • Lactic Acid • Linezolid  \nFull-text PDF: [https://www.amjcaserep.com/abstract/index/idArt/951194](https://www.amjcaserep.com/abstract/index/idArt/951194)  \n1826  1  1  16  \nPublisher’s note: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher  \nThis work is licensed under Creative Common AttributionNonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0)  \ne951194-1  \nIndexed in: [PMC] [PubMed] [Emerging S","cbCaibGz4aSJT0iZ","https://ap.wps.com/l/cbCaibGz4aSJT0iZ","pdf",292227,"English","# Case Report\n## Patient and clinical features\n## Laboratory and imaging findings\n# Diagnosis and treatment course\n## Linezolid exposure\n## Development of lactic acidosis\n# Conclusions\n## Clinical implications and stewardship","[{\"question\":\"Why was cellulitis difficult to diagnose in this elderly patient?\",\"answer\":\"The patient remained afebrile and without leukocytosis, reflecting an age-related blunted inflammatory response (immunosenescence) that can delay recognition and complicate care.\"},{\"question\":\"What organisms were found in the wound cultures?\",\"answer\":\"Wound cultures revealed polymicrobial organisms, including Pseudomonas aeruginosa, Klebsiella pneumoniae, and Stenotrophomonas maltophilia.\"},{\"question\":\"How was linezolid-associated lactic acidosis identified?\",\"answer\":\"During the final hospitalization, the patient developed lactic acidosis with elevated lactate levels in the absence of shock or hypoxemia, suggesting linezolid-induced mitochondrial toxicity after prolonged therapy.\"}]","Afebrile Recurrent Cellulitis Complicated by Linezolid-Induced Lactic Acidosis in an Elderly Patient | PDF",1790736935,13]