Diagnostic failure of ciprofloxacin-induced spontaneous bilateral Achilles tendon rupture: case-report and medical-legal considerations.

Abstract	Rare side-effects of fluoroquinolone therapy are tendinitis and tendon rupture. Many reports have demonstrated that the concomitant use of corticosteroids, in patients aged 60 years or older, increase the risk substantially. We present a case of spontaneous bilateral Achilles tendon rupture induced by ciprofloxacin and methylprednisolone. A 61-year-old woman was diagnosed with Bronchiolitis Obliterans with Organizing Pneumonia (BOOP) and was started on oral ciprofloxacin 500 mg twice daily for 3 weeks and on oral methylprednisolone 16 mg twice daily for 2 weeks. The diagnosis was made after doctors, rather than stop drug therapy and advise complete rest, had mistakenly prescribed for the woman to undergo physiotherapy and local NSAIDs, thus favoring the onset of tendon ruptures and resulting in surgical and legal implications. Inspired by this case, we also submit a brief review on professional liability in Orthopaedics.
Authors	A Pantalone, M Abate, C D'Ovidio, A Carnevale, V Salini
Journal	International journal of immunopathology and pharmacology (Int J Immunopathol Pharmacol) 2011 Apr-Jun Vol. 24 Issue 2 Pg. 519-22 ISSN: 0394-6320 [Print] England
PMID	21658328 (Publication Type: Case Reports, Letter, Review)
Chemical References	Anti-Infective Agents Anti-Inflammatory Agents, Non-Steroidal Glucocorticoids Ciprofloxacin Methylprednisolone
Topics	Achilles Tendon (diagnostic imaging, drug effects, surgery) Anti-Infective Agents (adverse effects) Anti-Inflammatory Agents, Non-Steroidal (adverse effects) Ciprofloxacin (adverse effects) Cryptogenic Organizing Pneumonia (drug therapy) Diagnostic Errors (legislation & jurisprudence) Female Glucocorticoids (adverse effects) Humans Informed Consent (legislation & jurisprudence) Liability, Legal Medication Errors (legislation & jurisprudence) Methylprednisolone (adverse effects) Middle Aged Physical Therapy Modalities (adverse effects) Risk Assessment Rupture, Spontaneous Tendon Injuries (chemically induced, diagnostic imaging, surgery) Ultrasonography

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