title: Levofloxacin-induced bilateral Achilles tendon rupture: a case report and review of the literature.
abstract: We present a rare case of spontaneous bilateral Achilles tendon rupture induced by levofloxacin, one of the fluoroquinolone antibiotics. A 76-year-old man was diagnosed with acute appendicitis and was commenced on oral levofloxacin 300 mg/day for 2 weeks. Seven days afterward he developed pain in both Achilles tendons, and at 14 days he developed swelling in the tendons. Four days later he felt a sharp, painful snap in both Achilles tendons while changing trousers. Both Achilles tendons ruptured completely at the mid-portion. There was no obvious underlying disease or pathophysiological factor causing fragility of his Achilles tendons. Despite the relatively large volume of case-based evidence, the pathophysiology of fluoroquinolone-induced tendinitis and tendon rupture is unclear. When tendinitis develops during fluoroquinolone therapy, the physician should consider the possible association between the fluoroquinolone and tendon rupture.
authors.affiliation: Department of Orthopaedic Surgery, Aomori Rosai Hospital, 1 Minamigaoka, Shirogane-machi, Hachinohe 031-8551, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Kowatari
authors.forename: Kikuo
authors.initials: K
authors.lastname: Nakashima
authors.forename: Atsushi
authors.initials: A
authors.lastname: Ono
authors.forename: Masakazu
authors.initials: M
authors.lastname: Yoshihara
authors.forename: Masafumi
authors.initials: M
authors.lastname: Amano
authors.forename: Satoshi
authors.initials: S
authors.lastname: Toh
mesh_terms: D000125:Achilles Tendon / Q000293:injuries* / Q000601:surgery; D000368:Aged; D000890:Anti-Infective Agents / Q000009:adverse effects*; D001064:Appendicitis / Q000188:drug therapy; D006801:Humans; D064704:Levofloxacin; D008297:Male; D015242:Ofloxacin / Q000009:adverse effects*; D012421:Rupture / Q000139:chemically induced
chemical_list: D000890:Anti-Infective Agents; D064704:Levofloxacin; D015242:Ofloxacin