Pulmonary embolism associated with spontaneous bilateral Achilles tendon rupture

Bilateral Achillies tendon ruptures are a rare occurrence that usually occur in patients with chronic systemic disease. Many cases are also associated with corticosteroid or fluoroquinolone use. Nonoperative treatment is generally indicated in this patient population, as the patients are often considered poor surgical candidates. Nonoperative immobilization, however, conveys the risk of developing deep venous thrombosis and pulmonary embolism. Such risks are even greater in patients displaying bilateral Achilles tendon ruptures. In this report, we illustrate the case of a near-fatal pulmonary embolism as associated with bilateral spontaneous Achilles tendon ruptures. We also review the current literature and make recommendations for prophylaxis and treatment of these potentially devastating complications.