Nephrotoxicity and purpura associated with levofloxacin.
OBJECTIVE
To report a patient with lung cancer and idiopathic myelofibrosis with myeloid metaplasia who developed purpura and acute renal failure while receiving levofloxacin, and review the existing literature on quinolone nephrotoxicity.


METHODS
A 73-year-old white man, with a medical history of non-small-cell lung cancer and idiopathic myelofibrosis with myeloid metaplasia, was prescribed levofloxacin because of a lower urinary tract infection. Three days later, he presented with palpable purpura and erythematous skin lesions over the lower limbs and trunk, with a markedly reduced urinary output. Serum creatinine and urea nitrogen were 6.4 and 190 mg/dL, respectively. Levofloxacin was discontinued, and prednisone, furosemide, and intravenous fluids were given. The patient fully recovered over the ensuing 4 weeks.


CONCLUSIONS
Nephrotoxicity associated with levofloxacin is uncommon. Allergic interstitial nephritis or vasculitis is believed to be the underlying pathologic process. Definitive diagnosis requires performance of renal biopsy, although this is not always feasible. In this case, a return of renal function to normal, with the disappearance of purpura following the discontinuation of levofloxacin and corticosteroid treatment, supports the presumptive diagnosis of a hypersensitivity reaction to levofloxacin.
Famularo
Giuseppe
G
Department of Internal Medicine, San Camillo Hospital, Rome, Italy. gfamularo@uni.net
De Simone
Claudio
C
D058186:Acute Kidney Injury / Q000139:chemically induced*; D000368:Aged; D000890:Anti-Infective Agents / Q000009:adverse effects*; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D004232:Diuretics / Q000627:therapeutic use; D003875:Drug Eruptions / Q000473:pathology; D005665:Furosemide / Q000627:therapeutic use; D006801:Humans; D007677:Kidney Function Tests; D064704:Levofloxacin; D008111:Liver Function Tests; D008175:Lung Neoplasms / Q000150:complications; D008297:Male; D009196:Myeloproliferative Disorders / Q000150:complications; D015242:Ofloxacin / Q000009:adverse effects*; D011241:Prednisone / Q000627:therapeutic use; D011693:Purpura / Q000139:chemically induced*
D000890:Anti-Infective Agents; D000893:Anti-Inflammatory Agents; D004232:Diuretics; D064704:Levofloxacin; D005665:Furosemide; D015242:Ofloxacin; D011241:Prednisone