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Reversible craniocervical dystonia associated with levofloxacin
Karlo J Lizarraga1, Maria R Lopez1, Carlos Singer1
1Department of Neurology, University of Miami, Miller School of Medicine, Clinical Research Building, 1120 NW 14th Street, 13th Floor, Miami, FL 33136 USA.
Journal of Clinical Movement Disorders
|January 21, 2016
Summary
Levofloxacin, an antibiotic, can rarely cause reversible craniocervical dystonia, a movement disorder. This case highlights potential risks, especially in older patients with kidney issues.
Area of Science:
- Neurology
- Pharmacology
Background:
- Dystonia is a movement disorder linked to basal ganglia and cortical circuit dysfunction.
- Gamma-aminobutyric acid (GABA) is the primary inhibitory neurotransmitter in the central nervous system.
- Quinolones may cause neurological side effects via GABA antagonism.
Observation:
- A 62-year-old male on hemodialysis developed craniocervical dystonia.
- Symptoms appeared 3 days after starting oral levofloxacin (500 mg twice daily).
- Levofloxacin was discontinued, and dystonia resolved within 7 days.
Findings:
- Levofloxacin can be a rare trigger for reversible craniocervical dystonia.
- Complete resolution of dystonia occurred within a week of drug cessation.
- No recurrence was observed over a 3-month follow-up period.
Implications:
- Clinicians should consider levofloxacin as a potential cause of dystonia.
- Older age, renal impairment, and high drug doses may increase risk.
- This case underscores the importance of monitoring for neurological side effects of quinolones.
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