Levofloxacin-induced gastrocnemius tendon rupture: a case report
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Updated: Jun 22, 2026
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Published on: September 19, 2016
1Ankara Dr. Abdurrahman Yurtaslan Oncology and Training Hospital, Ankara, Turkey. sarayavuz79@gmail.com.
Background:
Fluoroquinolone group antibiotics are frequently used in various infections such as urinary system, respiratory system, skin, and soft tissue infections owing to their broad spectrum and good antibacterial activity. Various tendon pathologies, especially tendinopathy, have been reported in literature most commonly in the Achilles tendon, but gastrocnemius tendon rupture has never been documented.
Case Presentation:
A 58-year-old Caucasian white female patient had knee and calf pain that started 10 days after levofloxacin treatment. Various differential diagnoses were excluded, and finally a knee magnetic resonance image scan was performed owing to the patient's history of diabetes and levofloxacin use 10 days prior. A significant effusion was detected in the lateral gastrocnemius muscle, and millimetric hypointense free tendon fragments were seen within the effusion. Therefore, gastrocnemius tendon rupture was diagnosed, and bed rest, extremity elevation, 900 mg acetaminophen, and cold application therapy were provided. During follow-up, the patient's extremity pain subsided, and walking function improved.
Conclusion:
By presenting this case, we aim to remind clinicians to keep in mind the rare tendon rupture possibilities other than Achilles tendon during fluoroquinolone group antibiotic therapy.
Insights
Fluoroquinolone antibiotics can rarely cause gastrocnemius tendon rupture, a condition not previously documented. This case highlights the importance of considering rare tendon injuries during fluoroquinolone therapy.
Area of Science:
- Orthopedics
- Pharmacology
- Radiology
Background:
- Fluoroquinolone antibiotics are widely used for various infections.
- Tendon pathologies, like Achilles tendinopathy, are known side effects.
- Gastrocnemius tendon rupture has not been previously documented with fluoroquinolone use.
Purpose of the Study:
- To report a rare case of gastrocnemius tendon rupture.
- To raise awareness among clinicians about potential fluoroquinolone-induced tendon injuries beyond the Achilles tendon.
Main Methods:
- A case presentation of a 58-year-old female patient experiencing calf pain post-levofloxacin treatment.
- Differential diagnoses were excluded, followed by a magnetic resonance imaging (MRI) scan.
- Diagnosis of gastrocnemius tendon rupture was confirmed via MRI findings.
Main Results:
- The patient developed knee and calf pain 10 days after levofloxacin treatment.
- MRI revealed significant effusion and free tendon fragments in the lateral gastrocnemius muscle.
- Conservative treatment (rest, elevation, pain management) led to symptom improvement and restored walking function.
Conclusions:
- This case underscores the possibility of gastrocnemius tendon rupture as a rare adverse effect of fluoroquinolone antibiotics.
- Clinicians should consider this rare diagnosis in patients on fluoroquinolones presenting with calf pain.
- Awareness of such rare tendon ruptures is crucial for timely diagnosis and management.
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