Abstract
Fluoroquinolones are known to cause rhabdomyolysis. Levofloxacin is a recent fluoroquinolone and its muscular toxicity is not well documented. We describe the case of a 77-year-old female patient, who presented with an acute rhabdomyolysis after treatment with levofloxacin. She had a background of serious cardio-pulmonary disease. She received an oral ambulatory treatment with levofloxacin for pulmonary infection. After 6 days, she presented with severe rhabdomyolysis, resulting in complete anuria with hyperkalaemia, complicated with acute liver cytolysis and respiratory failure. The treatment was a daily repeated haemodialysis. She presented with a fatal myocardial infarction 13 days after admission. The medical history inclines us to strongly suspect levofloxacin as the cause of this severe adverse drug reaction. We also reviewed 27 other suspect cases reported in the database provided by the World Health Organization Collaborating Centre for Drug Monitoring (Uppsala, Sweden). We conclude that rhabdomyolysis can be a rare, severe adverse effect of levofloxacin, as well as the other fluoroquinolones.
References
Baril L, Maisonobe T, Jasson-Molinier M, Haroche J, Bricaire F, Caumes E (1999) Acute rhabdomyolysis during treatment with ofloxacin—a case report. Clin Infect Dis 29:1598–1599
Guis S, Jouglard J, Kozak-Ribbens G, et al (2001) Malignant hyperthermia susceptibility revealed by myalgia and rhabdomyolysis during fluoroquinolone treatment. J Rheumatol 28:1405–1406
Blain H, Klein M, Weryha G, Trechot P, Hanesse B, Leclere J (1996) Rhabdomyolysis and unexplained malaise. Role of combination of ciprofibrate and norfloxacin. Rev Med Interne 17:859–860
Kashida Y, Kato M (1997) Toxic effects of quinolone antibacterial agents on the musculoskeletal system in juvenile rats. Toxicol Pathol 25:635–643
Nakamae H, Hino M, Yamane T et al (2000) A case of rhabdomyolysis due to levofloxacin. Clin Drug Invest 20:203–205
Brucato A, Bonati M, Gaspari F, et al (1993) Tetany and rhabdomyolysis due to surreptitious furosemide—importance of magnesium supplementation J Toxicol Clin Toxicol 31:341–344
Shintani S, Shiigai T, Tsukagoshi H (1991) Marked hypokalemic rhabdomyolysis with myoglobinuria due to diuretic treatment. Eur Neurol 31:396–398
Maresca MC, Calconi G, Amici GP, Teodori T, Da Porto A (1988) Hypopotassemia and rhabdomyolysis. Description of 3 cases of different etiologies. Minerva Med 79:55–60
Sato T, Takahashi K, Okuma Y, et al (2000) A senile case of acute necrotizing myopathy presenting prolonged severe muscle paralysis due to high dose glucocorticoid and muscle relaxant. Nippon Ronen Igakkai Zasshi 37:250–254
Portel L, Hilbert G, Gruson D, Favier JC, Gbikpi-Benissan G, Cardinaud JP (1999) Malignant hyperthermia and neuroleptic malignant syndrome in a patient during treatment for acute asthma. Acta Anaesthesiol Scand 43:107–110
Mallaret M, Mezin P, Chartier A (1993) Rhabdomyolysis in hypothyroidism. Favourable role of amiodarone. Presse Med 22:272
Gepner P, Botto H, Piette AM, Graveleau P, Chapman A (1990) Hypothyroid myopathy: apropos of a case with a great increase of creatine phosphokinase, myoglobinemia and transient kidney failure. Rev Med Interne 11:165–167
Acknowledgements
We would like to thank for his great help Ralph Edwards, Professor and Director, WHO Collaborating Center for International Drug Monitoring (Uppsala, Sweden).
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Petitjeans, F., Nadaud, J., Perez, J.P. et al. A case of rhabdomyolysis with fatal outcome after a treatment with levofloxacin. Eur J Clin Pharmacol 59, 779–780 (2003). https://doi.org/10.1007/s00228-003-0688-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00228-003-0688-x