Black Hairy Tongue Associated With Linezolid Treatment for Olecranon Bursitis Due to Streptococcus salivarius and Streptococcus mitis.

A 63-year-old female presented with acute, atraumatic posterior elbow pain. She was found to have infectious olecranon bursitis with resistant bacteria. Her treatment was complicated by a penicillin allergy, necessitating the use of linezolid, which was further complicated by the rare black hairy tongue (BHT) side effect of linezolid. Despite the visible discoloration and associated pain from BHT, the patient continued linezolid to treat her bursal infection. She recovered from the bursitis and linezolid side effects after completion, supporting that immediate withdrawal is not necessary for the resolution of BHT but should be part of shared decision-making to avoid early discontinuation of the antimicrobial.