Skip to main content

Official Journal of the Italian Society of Orthopaedics and Traumatology

  • Case Report
  • Published:

Spontaneous bilateral Achilles tendon rupture in a patient treated with oral levofloxacin

An Erratum to this article was published on 17 September 2007

Abstract

A case of bilateral rupture of the Achilles tendon in a patient treated with levofloxacin for cystitis is reported. A 76-year-old woman suddenly developed painful ankles one day after levofloxacin treatment. Drug therapy was switched to amoxicillin/clavulanate on the fourth day. Sonography revealed a serious condition of tendinosis with complete bilateral full-thickness rupture on day 6. Tendons were both repaired in the same surgical session. Pathological anatomy of the specimens reported fatty tissue lobules with panniculitis and histiocytosis. Ankles were immobilized postoperatively with a plaster cast. Achilles tendon rupture may occur as an adverse side effect of short-term use of levofloxacin, a fluoroquinolone antibiotic. This adverse effect is a rare and poorly understood complication of this antibiotic therapy. A review of the literature is provided.

References

  1. Lipsky BA, Baker CA (1999) Fluoroquinolone toxicity profiles: a review focusing on newer agents. Clin Infect Dis 28(2):352–364

    PubMed  CAS  Google Scholar 

  2. Pouzaud F, Rat P, Cambourieu C et al (2002) Tenotoxic potential of fluoroquinolones in the choice of surgical antibiotic prophylaxis in ophthalmology. J Fr Ophthalmol 25:921–926

    CAS  Google Scholar 

  3. Zabraniecki L, Negrier I, Vergne P et al (1996) Fluoroquinolone induced tendinopathy: report of 6 cases. J Rheumatol 23:516–520

    PubMed  CAS  Google Scholar 

  4. — (2002) Levaquin. In: Physicians’ desk reference, 5th edn. Medical Economics, Montvale, pp 2537–2543

  5. Wolfson JS, Hooper DC (1989) Fluoroquinolone antimicrobial agents. Clin Microbiol Rev 2:378–424

    PubMed  CAS  Google Scholar 

  6. Lewis JR, Gums JG (1999) Levofloxacin-induced bilateral Achilles tendonitis Ann Pharmacother 33:792–795

    Article  CAS  Google Scholar 

  7. Harrel RM (1999) Fluoroquinoloneinduced tendinopathy: what do we know? South Med J 92:622–625

    Google Scholar 

  8. Kowatari K, Nakashima K, Ono A et al (2004) Levofloxacin-induced bilateral Achilles tendon rupture: a case report and review of the literature. J Orthop Sci 9:186–190

    Article  PubMed  Google Scholar 

  9. Dekens-Konter JA, Knol A, Olsson S et al (1994) Tendinitis of the Achilles tendon caused by pefloxacin and other fluoroquinolone derivatives. Ned Tijdschr Geneeskd 138:528–531

    PubMed  CAS  Google Scholar 

  10. Movin T, Gad A, Guntner P et al (1997) Pathology of the Achilles tendon in association with ciprofloxacin treatment. Foot Ankle Int 18:297–299

    PubMed  CAS  Google Scholar 

  11. Ribard P, Audisio F, Kahn MF et al (1992) Seven Achilles tendinitis including 3 complicated by rupture during fluoroquinolone therapy. J Rheumatol 19:1479–1481

    PubMed  CAS  Google Scholar 

  12. West MB, Gow P (1998) Ciprofloxacin, bilateral Achilles tendonitis and unilateral tendon rupture—a case report. N Z Med J 111:18–19

    PubMed  CAS  Google Scholar 

  13. Pierfitte C, Royer RJ (1996) Tendon disorders with fluoroquinolones. Therapie 51:419–420

    PubMed  CAS  Google Scholar 

  14. Simonin MA, Gegout-Pottie P, Minn A et al (2000) Pefloxacin-induced achilles tendon toxicity in rodents: biochemical changes in proteoglycan synthesis and oxidative damage to collagen. Antimicrob Agents Chemother 44:867–872

    Article  PubMed  CAS  Google Scholar 

  15. Kashida Y, Kato M (1997) Characterization of fluoroquinolone-induced Achilles tendon toxicity in rats: comparison of toxicities of 10 fluoroquinolones and effects of anti-inflammatory compounds. Antimicrob Agents Chemother 41:2389–2393

    PubMed  CAS  Google Scholar 

  16. Zell RA, Santoro VM (2000) Augmented repair of acute Achilles tendon ruptures. Foot Ankle Int 21:469–474

    PubMed  CAS  Google Scholar 

  17. Donck JB, Segaert MF, Vanrenterghem YF (1994) Fluoroquinolones and Achilles tendinopathy in renal transplant recipients. Transplantation 58:736–737

    Article  PubMed  CAS  Google Scholar 

  18. Meyboom RH, Olsson S, Knol A et al (1994) Achilles tendinitis induced by pefloxacin and other fluoroquinolone derivatives. Pharmacoepidemiol Drug Saf 3:185–189

    Article  Google Scholar 

  19. Price AE, Evanski PM, Waugh TR (1986) Bilateral simultaneous achilles tendon ruptures. A case report and review of the literature. Clin Orthop Relat Res 213:249–250

    PubMed  Google Scholar 

  20. Royer RJ, Pierfitte C, Netter P (1994) Features of tendon disorders with fluoroquinolones. Therapie 49:75–76

    PubMed  CAS  Google Scholar 

  21. Smaill GB (1961) Bilateral rupture of the Achilles tendons. BMJ 1:1657–1658

    Article  Google Scholar 

  22. Fadda M, Piras S, Manunta A, Zirattu G (2006) A rare case of bilateral and simultaneous Achilles tendon rupture after levofloxacin therapy. Chir Piede 30:37–40

    Google Scholar 

  23. Rao SK, Navadgi BC, Vasdev A (2005) Bilateral spontaneous rupture of Achilles tendons: a case report. J Orthop Surg (Hong Kong) 13:178–180

    CAS  Google Scholar 

  24. Seeger JD, Pharm D, West WA et al (2006) Achilles tendon rupture and its association with fluoroquinolone antibiotics and other potential risk factors in a managed care population. Pharmacoepidemiol Drug Saf 15:784–792

    Article  PubMed  CAS  Google Scholar 

  25. Bailey RR, Kirk JA, Peddie BA (1983) Norfloxacin-induced rheumatic disease. N Z Med J 96:590

    PubMed  CAS  Google Scholar 

  26. McEwan SR, Davey PG (1988) Ciprofloxacin and tenosynovitis. Lancet 2:900

    Article  PubMed  CAS  Google Scholar 

  27. Perrot S, Ziza JM, De Bourran-Cauet G et al (1991) A new complication related to quinolones: rupture of Achilles tendon. Presse Med 20:1234

    PubMed  CAS  Google Scholar 

  28. Franck JL, Bouteiller G, Chagnaud P et al (1991) Achilles tendon rupture in 2 adults treated with pefloxacin, one of the cases with bilateral involvement. Rev Rhum Mal Osteoartic 58:904

    PubMed  CAS  Google Scholar 

  29. Karch FE, Lasagna L (1977) Toward the operational identification of adverse drug reactions. Clin Pharmacol Ther 21:247–254

    PubMed  CAS  Google Scholar 

  30. Lado Lado FL, Rodriguez Moreno C et al (2005) Partial bilateral rupture of the Achilles tendon associated to levofloxacin. An Med Interna 22:28–30

    PubMed  CAS  Google Scholar 

  31. Van der Linden PD, Van Puijenbroek EP, Feenstra J et al (2001) Tendon disorders attributed to fluoroquinolones: a study on 42 spontaneous reports in the period 1988 to 1998. Arthritis Rheum 45:235–239

    Article  PubMed  Google Scholar 

  32. Khaliq Y, Zhanel GG (2003) Fluoroquinolone-associated tendinopathy: a critical review of the literature. Clin Infect Dis 36:1404–1410

    Article  PubMed  Google Scholar 

  33. Shakibaei M, Pfister K, Schwabe R et al (2000) Ultrastructure of Achilles tendons of rats treated with ofloxacin and fed a normal or magnesium-deficient diet. Antimicrob Agents Chemother 44:261–266

    Article  PubMed  CAS  Google Scholar 

  34. Casparian JM, Luchi M, Moffat RE, Hinthorn D (2000) Quinolones and tendon ruptures. South Med J 93:488–491

    PubMed  CAS  Google Scholar 

  35. Gabutti L, Stoller R, Marti HP (1988) Fluoroquinolones as etiology of tendinopathy. Ther Umsch 55:558–561

    Google Scholar 

  36. Guerin B, Grateau G, Quartier G, Durand H (1996) Rupture of the long biceps tendon following ingestion of fluoroquinolone. Ann Med Interne (Paris) 147:69 (in French)

    CAS  Google Scholar 

  37. Levadoux M, Carli P, Gadea JF et al (1997) Repeated rupture of the extensor tendons of the hand due to fluoroquinolones. Apropos of a case. Ann Chir Main Memb Super 16:130–133 (in French)

    Article  PubMed  CAS  Google Scholar 

  38. Le Huec JC, Schaeverbeke T, Chauveaux D et al (1995) Epicondylitis after treatment with fluoroquinolone antibiotics. J Bone Joint Surg Br 77:293–295

    PubMed  Google Scholar 

  39. Jorgensen C, Anaya JM, Didry C et al (1991) Arthropathy with Achilles tendon involvement induced by pefloxacin. Apropos of a case. Rev Rhum Mal Osteoartic 58:623–625 (in French)

    PubMed  CAS  Google Scholar 

  40. Maffulli N (1999) Rupture of the Achilles tendon. J Bone Joint Surg Am 81:1019–1036

    PubMed  CAS  Google Scholar 

  41. Burkhardt O, Kohnlein T, Pap T, Welte T (2004) Recurrent tendinitis after treatment with two different fluoroquinolones. Scand J Infect Dis 36:315–316

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to A. E. Salvi.

Additional information

An erratum to this article is available at http://dx.doi.org/10.1007/s10195-007-0077-9.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Salvi, A.E., Metelli, G.P., Bosco, A. et al. Spontaneous bilateral Achilles tendon rupture in a patient treated with oral levofloxacin. J Orthopaed Traumatol 8, 86–90 (2007). https://doi.org/10.1007/s10195-007-0168-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10195-007-0168-7

Key words