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Ciprofloxacin-induced tendinopathy of the gluteal tendons
Kaumakaokalani Shimatsu1, Somasundaram Subramaniam, Helen Sim
1Department of Internal Medicine, University of California at Davis Internal Medicine Residency Program, 3100 PSSB 4150 V St., Sacramento, CA, 95817, USA.
Abstract:
Fluoroquinolone-induced tendinopathy most commonly affects the Achilles tendon; however, involvement of several other tendons has been described. This is a case report of ciprofloxacin-induced tendinopathy of the gluteal tendons with MRI findings. An obese 25-year-old woman with no significant past medical history was diagnosed with acute pyelonephritis and was treated with intravenous ciprofloxacin. Shortly after her first dose of ciprofloxacin, she developed severe left hip pain and decreased range of motion. MRI of the hips showed bilateral tendinopathy of the gluteal muscle insertion. A diagnosis of ciprofloxacin-induced tendinopathy was made based on her MRI and a Naranjo score of 7. Ciprofloxacin was stopped and her pain quickly resolved. Fluoroquinolones cause tendinopathy in 0.14 % to 0.4 % of patients using these agents. Fluoroquinolone-associated tendinopathy is a serious adverse reaction that can affect many tendons and should be considered in any patient presenting with new musculoskeletal complaints and in whom there is a history of fluoroquinolone use within the preceding 6 months.
Insights
Ciprofloxacin can cause gluteal tendon issues, a rare side effect of fluoroquinolone antibiotics. This case highlights the importance of considering drug-induced tendinopathy in patients with hip pain.
Area of Science:
- Orthopedics
- Pharmacology
- Radiology
Background:
- Fluoroquinolone antibiotics are widely used for bacterial infections.
- Tendinopathy is a known, albeit uncommon, adverse effect of fluoroquinolones, typically affecting the Achilles tendon.
- This case explores a less common presentation of fluoroquinolone-induced tendinopathy.
Observation:
- A 25-year-old woman developed severe hip pain and limited motion shortly after receiving intravenous ciprofloxacin for pyelonephritis.
- Magnetic Resonance Imaging (MRI) revealed bilateral tendinopathy at the gluteal muscle insertion sites.
- The patient's symptoms rapidly improved after discontinuation of ciprofloxacin.
Findings:
- The diagnosis of ciprofloxacin-induced tendinopathy was supported by MRI findings and a Naranjo score of 7.
- The incidence of fluoroquinolone-associated tendinopathy ranges from 0.14% to 0.4%.
- Gluteal tendon involvement represents an atypical manifestation of this adverse drug reaction.
Implications:
- Clinicians should consider fluoroquinolone-induced tendinopathy in patients with new musculoskeletal complaints, especially hip pain.
- A history of fluoroquinolone use within the past six months is a critical factor in diagnosis.
- Prompt recognition and cessation of the causative agent can lead to rapid symptom resolution and prevent further complications.
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