Sugimoto Toshiro, Kaneko Hideto, Deji Naoko, Koya Daisuke
Department of Internal Medicine, Shiga University of Medical Science, Seta, Otsu, 520-2192, Japan.
Mod Rheumatol. 2005;15(3):217-9. doi: 10.1007/s10165-005-0393-y.
We report a case of spontaneous Achilles tendon rupture associated with myeloperoxidase-anti-neutrophil cytoplasmic antibody (MPO-ANCA)-related microscopic polyangiitis in a 77-year-old man who was treated with oral corticosteroids. Several days after 10 days of treatment with levoflaxacin (daily dose 200 mg) for bacterial pneumonia, he noted discomfort around both Achilles tendons. The discomfort developed into swelling around his left ankle, and he could not walk well. We diagnosed bilateral Achilles tendinitis with spontaneous rupture induced by levofloxacin. Epidemiological studies show that the risk of fluoroquinolone-related tendon rupture is highest among patients over the age of 60 years who are receiving a corticosteroid. Rupture of the Achilles tendon is a rare but serious side effect of fluoroquinolone usage. Thus, physicians should be aware of this adverse effect, especially when prescribing medication for aged patients being treated with corticosteroids.
我们报告一例77岁男性患者，其患有与髓过氧化物酶抗中性粒细胞胞浆抗体（MPO-ANCA）相关的显微镜下多血管炎，并伴有自发性跟腱断裂，该患者接受了口服皮质类固醇治疗。在用左氧氟沙星（每日剂量200mg）治疗细菌性肺炎10天后的几天，他注意到双侧跟腱周围不适。这种不适发展为左脚踝周围肿胀，且他无法正常行走。我们诊断为左氧氟沙星诱发的双侧跟腱炎伴自发性断裂。流行病学研究表明，在接受皮质类固醇治疗的60岁以上患者中，氟喹诺酮类药物相关肌腱断裂的风险最高。跟腱断裂是使用氟喹诺酮类药物罕见但严重的副作用。因此，医生应意识到这种不良反应，尤其是在为接受皮质类固醇治疗的老年患者开药时。
