Levofloxacin-induced bilateral Achilles tendonitis

OBJECTIVE: To report a case of possible levofloxacin-induced bilateral Achi lles tendonitis, CASE SUMMARY: An 83-year-old white woman presented to her physician with fi ve days of hemoptysis. She was diagnosed with right lower-lobe pneumonia ba sed on chest X-ray, and levofloxacin 500 mg/d po for 10 days was prescribed . Three days into treatment she began having a variety of adverse effects, including severe nausea, constipation, stomach cramps, and dizziness. Signs of tendonitis began three days after treatment and peaked four days after completion of therapy. Two weeks later, she was treated by her podiatrist w ith an ankle immobilizer and rest. At her three-week follow-up, she had mar ked improvement in her pain and bruising; however, her symptoms had not com pletely resolved. DISCUSSION: Tendonitis and tendon rupture are rare adverse effects of fluor oquinolone antibiotics; there are no reports in the Literature of levofloxa cin-induced tendonitis. As newer fluoroquinolones become available, the pos tmarketing studies will become increasingly important to capture the data o n rare but serious adverse effects not discovered in the premarketing trial s. CONCLUSIONS: To our knowledge, this is the Oat reported case of tendonitis caused by levofloxacin reported in the literature. Reports have been made, however, to the manufacturer via postmarketing surveillance. As more people are treated with newer fluoroquinolones, the clinical incidence of tendon rupture with these agents may become clearer.