Achilles tendon disease in lung transplant recipients: association with ciprofloxacin

Abstract

Achilles tendon disease in lung transplant recipients: association with ciprofloxacin. P.N. Chhajed, M.L. Plit, P.M. Hopkins, M.A. Malouf, A.R. Glanville. #ERS Journals Ltd 2002. ABSTRACT: Achilles tendonitis or rupture are uncommon complications following the use of fluoroquinolones, with a reported incidence in the general population of 0.4%. The aims of the current study were to determine the incidence of Achilles tendon disease (ATD) in lung transplant recipients (LTR) and to identify risk factors.Questionnaires were sent to 150 LTR of whom 101 responded (67%). Twenty-two LTR (21.8%) experienced ATD (tendonitis 16, rupture six). The mean age of LTR who developed ATD was 52.9 ¡ 6.1 yrs (range: 19-63.5 yrs).Only the use of ciprofloxacin was significantly associated with ATD (pv0.05). Age, sex, underlying disease necessitating transplantation, serum creatinine and cyclosporine levels were not associated with ATD. The association between ciprofloxacin and ATD was not dose related. Of the 72 LTR who had received ciprofloxacin, 20 (28%) developed ATD (tendonitis 15, rupture five). In patients receiving ciprofloxacin, there was no association between the mean cumulative dose of prednisolone and ATD. Tendon rupture occurred with a lower ciprofloxacin dosage than tendonitis and the mean recovery duration was significantly longer.To conclude, lung transplant recipients receiving ciprofloxacin are at significant risk of developing Achilles tendon disease. The association between ciprofloxacin and Achilles tendon disease appears to be idiosyncratic rather than dose-related.

Synergistic effects of dexamethasone and quinolones on human-derived tendon cells

“…This is in contrast to clinical observations and to our results but might be explained by the short treatment period of only 24 h. In a typical clinical situation, A c c e p t e d M a n u s c r i p t 16 patients are treated chronically with glucocorticoids for indications such as pulmonary diseases or following organ transplantation [14,50].…”

Quinolone-related Achilles Tendinopathy in Heart Transplant Patients: Incidence and Risk Factors

“…Similarly, the fact that the 13:1 (M:F) gender ratio in our AT patients was not statistically significant is probably attributable to the small proportion of women in our sample; other studies have also found AT to be more frequent among men. 3,10,14 Little is known of the pathophysiologic mechanisms leading to quinolone-induced tendinopathy. Jorgensen et al 15 and Beuchar et al 16 suggested that an ischemic vascular process leading to tissue necrosis may cause the disorder, and LeHuec et al 17 indicated that it may be due to direct toxic insult to tendon collagen.…”

“…Tendinitis was diagnosed if the tendon was painful upon walking and palpation and showed signs of local inflammation 5 during the first 30 days after the first quinolone dose. 10 Tendon rupture was diagnosed if Thompson's test 9 was positive. In unclear cases, an ultrasound study was performed.…”

“…Individual risk for this complication is low among healthy people, 0.14% to 0.40%, 8 but is increased by conditions such as old age, long-term corticosteroid therapy and kidney failure. 6,9 In particular, a very high incidence of quinolone-related Achilles tendinopathy (AT) has been reported among kidney 10 and lung 11 transplant patients, although for reasons not completely known. To the best of our knowledge, no studies have investigated whether the same is true among patients with heart grafts.…”

Fluorochinolon-induzierte Achillessehnenruptur

“…Unsere Patientin wies eine Kombination aller genannten Risikofaktoren auf. Auch bei Patienten mit Zustand nach Nieren- [2] und Lungentransplantation [1] wurde über das Auftreten einer Tendopathie berichtet. Ob aber die Transplantation ein eigenständiger Risikofaktor für die Tendopathie ist, erscheint eher unwahrscheinlich.…”