Rotura parcial bilateral aquílea asociada a levofloxacino

Abstract

Fluoroquinolones-associated tendonitis and tendon rupture are well described in the literature but these are not frequently observed and related to the new agents of this group, as levofloxacin. This is probably due to the recent introduction and expansion. Although epidemiological studies are needed to know the frequency of that levofloxacin-induced tendinopathies, case-report could alert to the physicians about this possible severe adverse reaction. We present a case of bilateral Achilles tendonitis with partial spontaneous rupture probably associated to levofloxacin.

Bilateral Levofloxacin-Induced Achilles Tendon Rupture: An Uncommon Case Report and Review of the Literature

“…Most researchers agree that the onset of symptoms may vary from 2 hours after FQ-intake to as far as 6 months. The mean time of symptom onset is about 2 weeks, and in 50% of cases, symptoms started within 6 to 7 days after drug intake, 1,2,5,7,8,10,15,16 as it was in our case report. Fluoroquinolones-induced Achilles tendinopathy shows a direct cause-effect relationship, and tendinopathy usually appears during the first week of treatment, and rupture usually occurs during the next week, that is, 2 weeks after treatment.…”

“…Fluoroquinolones are a group of antibiotics with a broad spectrum of activity; they are therefore used more and more frequently in the management of infections. 8 Levofloxacin is recommended for the management of community-acquired pneumonia, in doses of 500 mg, once or twice a day for up to 7 to 10 days, 2,9,10 as it was prescribed in our case report.…”

“…1 Fluoroquinolones-induced tendinopathy is a very rare complication. 5,9,10 Achilles tendinopathy and tendon rupture are adverse side effects of levofloxacin treatment well recognised in the literature, but its presentation is very uncommon. 9 The incidence rate for tendinopathy is 0.1% to 0.01%, and the incidence rate for tendon rupture is less than 0.01%.…”

“…5,8,9,11,12 Some reviews state that men are more likely to develop this side effect. 5,13 Lado Lado et al 10 state that the men/women ratio is 3:1 for FQ-induced tendinopathy.…”

“…It is believed that the different chemical structure of newer FQ (levofloxacin, ofloxacin and pefloxacin) makes them more toxic on cartilages and tendons than older FQ (norfloxacin, ciprofloxacin and enoxacin). 10,17…”