Levofloxacin-induced Achilles tendon rupture in a patient with systemic microscopic polyangiitis

Abstract

We report a case of spontaneous Achilles tendon rupture associated with myeloperoxidase-anti-neutrophil cytoplasmic antibody (MPO-ANCA)-related microscopic polyangiitis in a 77-year-old man who was treated with oral corticosteroids. Several days after 10 days of treatment with levoflaxacin (daily dose 200 mg) for bacterial pneumonia, he noted discomfort around both Achilles tendons. The discomfort developed into swelling around his left ankle, and he could not walk well. We diagnosed bilateral Achilles tendinitis with spontaneous rupture induced by levofloxacin. Epidemiological studies show that the risk of fluoroquinolone-related tendon rupture is highest among patients over the age of 60 years who are receiving a corticosteroid. Rupture of the Achilles tendon is a rare but serious side effect of fluoroquinolone usage. Thus, physicians should be aware of this adverse effect, especially when prescribing medication for aged patients being treated with corticosteroids.

Fluoroquinolone (Levofloxacin) Induced Tendinopathy with Partial Tearing of the Achilles Tendon -A Case Report

“…Of these, age and respiratory disease like asthma and COPD are the most important if patient is on corticosteroids therapy [29]. Secondly, antibiotics should be chosen based upon the most likely patients and test should be performed to identify the type of patient so that suitable and appropriate antibiotics can be prescribed [30,31] . Thus, it is practical and critical that the physicians always considers the drug adverse effects in disease diagnostic approach and these antibiotics drugs should be prescribed with more caution to patients susceptible to developing fluoroquinolone-induced tendinopathy.…”