ACHILLES TENDINITIS: A RARE ADVERSE REACTION TO LEVOFLOXACIN

TYPE: Abstract Publication TOPIC: Pharmacotherapeutics PURPOSE: Fluroquinolones are a safe and an effective class of antibiotics. Musculoskeletal reactions are unusual and include tendinitis (< 0.01%) and tendon rupture (0.1 - 0.01%). Any tendon can be affected, but Achilles tendon is vulnerable, presumably because it supports the body weight. METHODS: A 80 years-old male with previously diagnosed with Chronic Pulmonary Obstructive Disease (CPOD) Gold 3 presented in internal medicine consultation with a 3-day history of fever, worsening off usual breathless, increase in frequency of cough and darker sputum colour. It was diagnosed a CPOD exacerbation and he intensified bronchodilators therapy and started a short-term of systemic glucocorticoid and a course of antibiotic, namely Levofloxacin 500 mg, id, 7 days. After 8 days of the first dose of Levofloxacin antibiotic the patient developed pain and swelling in right ankle, associated with functional limitation. He doesn’t have previous history of acute or cumulative trauma, so we suspected right Achilles tendinitis caused by Levofloxacin. An ultrasound examination was performed confirmed the diagnosis, revealed enthesopathy with thickness of insertion of right Achilles tendon (6 mm vs 4 mm) and excluded signals of tendon rupture. RESULTS: The course of antibiotic was already done, so it wasn’t necessary to suspend and the symptoms improved gradually. CONCLUSIONS: Fluroquinolone are a safe class of antibiotics and adverse reaction such tendinopathies of Achilles tendon are extremely rare. CLINICAL IMPLICATIONS: It’s important to be aware, especially in patients with risk factors for tendon fragility, particularly the elderly with multiple pathologies. DISCLOSURE: No significant relationships. KEYWORDS: Levofloxacin, Achilles Tendinitis