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Published on: June 6, 2025
[Fluoroquinolone-induced Achilles tendon rupture]
1Internist/Nephrologie, Intensivmedizin, Bonn. maurin@t-online.de
Deutsche Medizinische Wochenschrift (1946)
|February 1, 2008
Summary
Fluoroquinolone antibiotics can cause Achilles tendon rupture, especially in older patients with diabetes, COPD, and kidney disease. This case highlights the risk of fluoroquinolone-induced tendinopathy (FIT) and the need for careful patient selection.
Area of Science:
- Pharmacology
- Orthopedic Surgery
- Nephrology
Background:
- A 72-year-old female dialysis patient with diabetes and COPD was treated with levofloxacin for acute bronchitis.
- She had a history of long-term oral prednisolone use.
Observation:
- One day after completing levofloxacin, she experienced heel pain.
- Twelve days post-treatment, she developed calf pain and lost active plantar flexion.
- Physical examination revealed a gap in the Achilles tendon and a positive Thompson test.
Findings:
- Ultrasonography confirmed a discontinuity of the right Achilles tendon.
- A diagnosis of spontaneous Achilles tendon rupture secondary to fluoroquinolone use was made.
- The patient presented with multiple risk factors for tendinopathy: age over 60, long-term glucocorticoid use, and chronic kidney disease.
Implications:
- Fluoroquinolone-induced tendinopathy (FIT) can have a significant latency period.
- Patients with risk factors like advanced age, glucocorticoid use, and chronic kidney disease are at increased risk.
- Caution and dose adjustment are recommended when prescribing fluoroquinolones to patients with multiple risk factors, particularly in nephrologic and dialysis populations.
