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Intractable Acute Pain Related to Fluoroquinolone-Induced Peripheral Neuropathy
Abstract:
Fluoroquinolones are widely prescribed antibiotics, used for various infectious etiologies. These antibiotics carry the possibility of the serious adverse effect of peripheral neuropathy, with a true incidence not known owing to its rare existence. Recently, the Food and Drug Administration (FDA) has required alterations to drug labels to highlight this adverse effect of fluoroquinolones. This is a case report of a single patient at an inpatient neurology service at an urban academic medical center in the United States. The patient is a 20-year-old male, with well-controlled type 1 diabetes mellitus, presenting with a short duration of bilateral lower extremity pain following a 10-day course of levofloxacin for suspected epididymitis. The patient was initially diagnosed with complex regional pain syndrome and treated with a variety of pain medications, including lidocaine infusions, hydromorphone, methadone, and ketamine infusions. After review of the patient's history and limited response to medical management, the patient's condition was reclassified as an adverse effect from fluoroquinolone treatment. Pain of unknown etiology can be perplexing, both for the physician and the patient. Reporting of similar incidents attributed to medication adverse effects will increase the awareness of this type of neuropathy, avoid future cases of misdiagnosis, and enable early detection and treatment.
Insights
Fluoroquinolone antibiotics, like levofloxacin, can cause peripheral neuropathy, a serious nerve condition. This case highlights the importance of recognizing this rare adverse effect to ensure accurate diagnosis and prompt treatment.
Area of Science:
- Neurology
- Pharmacology
Background:
- Fluoroquinolones are broad-spectrum antibiotics frequently prescribed for bacterial infections.
- Peripheral neuropathy is a recognized but rare adverse effect associated with fluoroquinolone use.
- The U.S. Food and Drug Administration (FDA) mandated updated drug labels to emphasize this risk.
Observation:
- A 20-year-old male with type 1 diabetes developed bilateral lower extremity pain after a 10-day course of levofloxacin.
- Initial diagnosis was complex regional pain syndrome, with treatment including lidocaine, hydromorphone, methadone, and ketamine infusions.
- The patient showed limited response to initial pain management strategies.
Findings:
- The patient's symptoms were ultimately attributed to fluoroquinolone-induced peripheral neuropathy.
- This diagnosis was made after re-evaluation of the clinical presentation and treatment history.
- The neuropathy presented as bilateral lower extremity pain.
Implications:
- Accurate identification of fluoroquinolone-induced neuropathy is crucial for appropriate patient management.
- Increased awareness of this adverse effect can prevent misdiagnosis and delayed treatment.
- Reporting such cases aids in understanding the true incidence and clinical spectrum of fluoroquinolone neurotoxicity.