The
fluoroquinolones are
antibiotics widely used in the clinical practice. The concomitant use of
corticosteroids and
fluoroquinolones in elderly patients is recognised as a risk factor for developing clinically relevant tendon lesions.
Fluoroquinolone-induced
tendinopathy is underreported in the literature. A 67-year-old man, came to our observation complaining of 5 days history of bilateral heel
pain. The patient had a medical history of
sarcoidosis and was treated with a daily dose of 5 mg of
prednisone. He was initially given oral
levofloxacin (500 mg/die) for 10 days, because of an acute respiratory
infection. Two days before the end of the
antibiotic therapy, he developed bilateral heel
pain. He denied any history of
trauma. Physical examination revealed swelling and marked tenderness with mild palpation of the Achilles tendons at the calcaneal insertion. The ultrasound evaluation of the Achilles tendons revealed the following main abnormalities: diffuse thickening, loss of the "fibrillar" echotexture, blurred margins, and bilateral partial tendon tears. Bilateral Achilles tendon
pain and
rupture has been described as a rare adverse effect of
fluoroquinolone treatment. Most of the
fluoroquinolone-induced
tendinopathies of the Achilles tendon are due to
ciprofloxacin. To the best of our knowledge, this is the first description of bilateral Achilles tendon
rupture due to
levofloxacin. The risk/benefit ratio of the
fluoroquinolones should be carefully considered and these drugs should be prescribed cautiously in elderly patients treated with
corticosteroids. This case can be regarded as a representative example of the potential clinical efficacy of sonography in daily rheumatological practise.