Achilles is not alone!!! Ciprofloxacin induced tendinopathy of gluteal tendons

Extract

Tendinopathy is a rare adverse effect of fluoroquinolones use and occurs only in ∼0.4% of patients taking these medications. Fluoroquinolones-induced tendinopathy (FIT) most commonly involves Achilles tendons but involvement of other tendons has also been rarely described in literature. Here, we describe a rare case of Ciprofloxacin induced tendinopathy involving gluteal tendons.

A 72-year-old male with past medical history of Diabetes mellitus type 2 and end stage renal disease (ESRD) on hemodialysis presented to emergency department with complaints of lower back pain of 2 weeks duration which was radiating to both his legs. Pain was insidious in onset, gradually progressive and had started to hinder in patient’s day to day life. Patient denied history of trauma, fever and bowel and bladder incontinence. On physical examination, patient had minimal tenderness on lumbar spine on deep palpation. Deep tendon reflexes were decreased in both lower extremities. Laboratorial examination was consistent with anemia of chronic disease, diabetes and ESRD. Magnetic resonance imaging (MRI) of lumbar spine revealed T1 hyperintensity at L3-L4 vertebrae with adjacent edema at the right psoas muscle suspicious of discitis or osteomyelitis for which patient was started on IV vancomycin and oral Ciprofloxacin. After 4 days of antibiotics therapy, patient started to complain of acute right hip pain. There was diffuse tenderness on palpation in trochanteric area. Patient even refused to get up from bed for examination of his gait. MRI of right hip revealed mild partial tearing of the right gluteus medius tendon insertion and at the origin of the right hamstring tendons ( Figure 1 ). Patient was suspected to have Fluoroquinolone-induced tendinopathy (FIT) and Ciprofloxacin was discontinued. Orthopedics advised conservative management with physical therapy because of patient’s bacteremia. Patient’s pain started to improve after discontinuation of Ciprofloxacin and he was later transferred to an acute rehabilitation facility in stable condition.