Levofloxacin-induced dyskinesia in an elderly patient with granulomatosis with polyangiitis

This case report presents an early 60s male patient who developed generalised tremor and dyskinesia within 24 hours of initiating levofloxacin treatment for community-acquired pneumonia and was diagnosed with granulomatous polyangiitis. The patient was receiving immunosuppressive therapy with rituximab and corticosteroids. Neurological examination revealed choreiform movements and gait disturbance, but laboratory parameters, including brain imaging and kidney and liver function tests, were normal. Alternative causes, such as infections, metabolic imbalances and neurodegenerative conditions were ruled out. After levofloxacin was discontinued, the patient's symptoms improved rapidly, and complete recovery was observed within 1 week. A literature review revealed that the number of similar cases is limited. This case demonstrates that levofloxacin-induced movement disorders, although rare, may occur, particularly in elderly patients or those with underlying comorbidities. Proposed mechanisms include GABA-A receptor inhibition and NMDA receptor activation, which contribute to neuronal hyperexcitability. This case highlights the importance of recognising fluoroquinolone-induced neurotoxicity as a potential side effect, particularly in susceptible populations.