Levofloxacin-induced bilateral Achilles tendon rupture: a case report and review of the literature

We present a rare case of spontaneous bilateral Achilles tendon rupture induced by levofloxacin, one of the fluoroquinolone antibiotics. A 76-year-old man was diagnosed with acute appendicitis and was commenced on oral levofloxacin 300mg/day for 2 weeks. Seven days afterward he developed pain in both Achilles tendons, and at 14 days he developed swelling in the tendons. Four days later he felt a sharp, painful snap in both Achilles tendons while changing trousers. Both Achilles tendons ruptured completely at the mid-portion. There was no obvious underlying disease or pathophysiological factor causing fragility of his Achilles tendons. Despite the relatively large volume of case-based evidence, the pathophysiology of fluoroquinolone-induced tendinitis and tendon rupture is unclear. When tendinitis develops during fluoroquinolone therapy, the physician should consider the possible association between the fluoroquinolone and tendon rupture.