Achilles Tendinitis and Tendon Rupture Due to Fluoroquinolone Antibiotics

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Abstract
Tendinitis and tendon rupture are unusual and unexpected side effects of drugs1,2. An 85-year-old man had been treated for polymyalgia rheumatica with prednisone. His condition improved in the next three months, and the dose of prednisone was reduced to 15 mg per day. Two weeks later a urologist prescribed enoxacin (two 200-mg tablets twice a day) for a urinary tract infection. On the seventh day of enoxacin therapy, pain developed in both calves radiating to the heels. The patient noted mild swelling in the lower extremities. On examination a week later he had difficulty walking because of pain in his lower legs. There was marked tenderness to palpation in both Achilles tendons. The ankle reflexes were normal. Fluoroquinolone-induced bilateral Achilles tendinitis was suspected, and nabumetone was prescribed. The patient continued to have difficulty walking, and twelve days later a defect was palpated in the right Achilles tendon. Magnetic resonance imaging showed a complete rupture of the right Achilles tendon approximately 3 cm above the calcaneus. The patient was treated with a brace on the right ankle, with improvement in pain. The pain in the left calf and Achilles tendon resolved.

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