Case reportKidney transplantationFluoroquinolones-Induced Tendinitis and Tendon Rupture in Kidney Transplant Recipients: 2 Cases and a Review of the Literature
Section snippets
Case 1
A 54-year-old woman suffered renal failure for 4 years, received vascular dialysis for 2 years, and was finally submitted to undergo double kidney transplantation 1 year ago (from a marginal donor). She received immunosuppressive therapy with prednisolone (4 mg/d), cyclosporine (150 mg/d), and mycophenolate (1000 mg/d). Six months after transplantation, she started a 10-day antibiotic course with ciprofloxacin (500 mg twice daily) for a urinary tract infection. Two weeks later, 5 days after the
Case 2
A 60-year-old woman suffered renal failure with hyperparathyroidism for a Berger disease since 1998. She underwent vascular dialysis in 2000 and transplantation in 2002. Immunosuppressive therapy was based on prednisolone (8 mg/d), azathioprine (50 mg/d), and Fk (2.5–3 mg/d). She received ciprofloxacin for 7 days to treat a urinary tract infection. During the antibiotic course, she experienced pain in the left Achilles tendon with local edema and difficulty in standing up or during ambulation.
Discussion
Tendon disorders associated with fluoroquinolones have been estimated to occur at a rate of approximately 15–20 per 100,000 patients.12 Tendinitis involves most commonly Achilles tendons, but also quadriceps, peroneus brevis, extensor pollicis longus, long head of biceps, and rotator cuff tendons.12 Possible risk factors have been investigated. Long-term steroid therapy, renal insufficiency, advanced age, prior tendinopathies, magnesium deficiency, hyperparathyroidism, diuretic use, peripheral
Conclusions
Awareness of the association between tendon disorders and fluoroquinolones should lead to a careful assessment of patients. The evaluation of specific risk factors and an enhanced surveillance for suspicious symptoms, especially in transplant recipients, should be mandatory. Patients should be correctly advised of the possibility of tendon disorders, during or after fluoroquinolone treatment, and counselled to immediately suspend treatment and to rest when symptoms occur. Furthermore, even if
References (28)
- et al.
Fluoroquinolones cause changes in extracellular matrix, signalling proteins, metalloproteinases and caspase-3 in cultured human tendon cells
Toxicology
(2005) The place of quinolones in everyday clinical practice
Chemotherapy
(1996)- et al.
Fluoroquinolones antimicrobial agents
N Engl J Med
(1991) - et al.
A reappraisal of quinolone tolerabilityThe experience of their musculoskeletal adverse effects
Drug Saf
(1995) Fluoroquinolone toxicitiesAn update
Drugs
(1995)- et al.
Norfloxacin-induced rheumatic disease
N Z Med J
(1983) - et al.
A new complication related to quinolones: rupture of Achilles tendon
Presse Med
(1991) - et al.
Achilles tendon rupture in 2 adults treated with pefloxacin, one of the cases with bilateral involvement
Rev Rhum Mal Osteoartic
(1991) Achilles tendinitis and tendon rupture due to fluoroquinolones
N Engl J Med
(1994)- et al.
More on fluoroquinolone antibiotics and tendon rupture
N Engl J Med
(1995)
Fluoroquinolone-induced tendinopathy: what do we know?
South Med J
Fluoroquinolones and risk of Achilles tendon disorders: case-control study
BMJ
Fluoroquinolone induced tendinopathy: report of 6 cases
J Rheumatol
Biochemical changes in Achilles tendon from juvenile dogs after treatment with ciprofloxacin or feeding a magnesium-deficient diet
Arch Toxicol
Cited by (22)
Anti-Infectives
2020, Drug-Induced Ocular Side Effects, Eigtht EditionBilateral Achilles Tendon Ruptures Associated With Ciprofloxacin Use in the Setting of Minimal Change Disease: Case Report and Review of the Literature
2016, Journal of Foot and Ankle SurgeryCitation Excerpt :Several studies have reported the occurrence of bilateral Achilles tendinopathy after quinolone use (9,10,13). Our patient was predisposed to this complication owing to 3 well-established risk factors (26,27): his advanced age, steroid intake, and renal compromise. Our report, however, is the first to introduce a case of minimal change disease, which represents a particular population of patients with renal compromise, mainly the nephrotic syndrome subset.
Musculoskeletal Complications of Fluoroquinolones: Guidelines and Precautions for Usage in the Athletic Population
2011, PM and RCitation Excerpt :Subsequent to these initial reports, multiple cases of fluoroquinolone-associated tendinopathy have been published. Among reported cases, the Achilles tendon is most commonly involved [3,4,7,11,13,27-58]. However, multiple other tendons and tendon groups have been involved, including the common extensor tendon origin of the lateral elbow [59], subscapularis [55], biceps brachii [41], brachioradialis [40], adductor longus [60], plantar foot tendons [61], rectus femoris [62], flexor hallucis longus [63], supraspinatus, extensor pollicis longus, quadriceps, and patellar [3], and the tendons of the extraocular muscles [64].
Parathyroid Disease
2010, Rheumatic Disease Clinics of North AmericaCitation Excerpt :The most common site of tendon pathology is the Achilles tendon, but other sites (eg, epicondyle, rotator cuff, finger, or thumb) may be involved.105 In approximately half of patients, Achilles tendonitis is bilateral.106 At radiography, sclerotic bands along the superior and inferior thoracic and lumbar vertebral body endplates give a striped appearance to the vertebral bodies, with a relative band of lucency at the center of each vertebral body (Fig. 6).
Fluoroquinolone resistance in campylobacter
2010, Journal of Food Protection