A 71-year-old man who had been received chemotherapy for intrahepatic cholangiocarcinoma presented with a fever for the previous 3 days. As laboratory studies showed mildly elevated liver tests, we diagnosed him with cholangitis, and oral levofloxacin (500 mg/day) was initiated. Five days later, he noted the immediate onset of pain in his left ankle without any physical activity followed by swelling of his left lower leg. Subsequent ultrasound and computed tomography revealed Achilles tendon rupture (Picture 1, 2). He received conservative treatment, and his pain quickly resolved. Fluoroquinolone antibiotics have been gaining increased attention because of the associated adverse events of tendinitis and tendon rupture (1). These adverse events can occur as early as a few hours after the initial dose or up to six months after drug therapy (2). The reported risk factors are concomitant steroid therapy, renal insufficiency, and advanced age (>60 years of age) (1,2), and the present patient's age corresponded with these risk factors.
Picture 1.
Picture 2.
The author states that he has no Conflict of Interest (COI).
References
- 1.Bidell MR, Lodise TP. Fluoroquinolone-associated tendinopathy: does levofloxacin pose the greatest risk? Pharmacotherapy 36: 679-693, 2016. [DOI] [PubMed] [Google Scholar]
- 2.Gold L, Igra H. Levofloxacin-induced tendon rupture: a case report and review of the literature. J Am Board Fam Pract 16: 458-460, 2003. [DOI] [PubMed] [Google Scholar]