A case of rhabdomyolysis with fatal outcome after a treatment with levofloxacin

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.

Acute Rhabdomyolysis Associated with Coadministration of Levofloxacin and Simvastatin in a Patient with Normal Renal Function

“…Acute rhabdomyolysis has been previously reported in patients under hemodialysis [9] or after renal transplantation [10]. Petitjeans et al described in 2003 a case of an elderly patient with severe rhabdomyolysis, suffering from acute renal failure [8]. In our case renal function was normal at the beginning of the therapy and remained intact all along the severe clinical course, indicating that the adverse event is also probable in patients without renal impairment.…”

“…It has a predominant renal elimination and dose reduction is necessary in patients with renal dysfunction [7]. Acute rhabdomyolysis due to Levofloxacin has been previously reported in elderly patients [8], in patients under hemodialysis [9], or after renal transplantation [10]. We report a rare case of severe acute rhabdomyolysis associated with coadministration of levofloxacin and simvastatin in a 70-year-old Caucasian male with normal renal function.…”

Levofloxacin‐induced rhabdomyolysis in a hemodialysis patient

“…There have been several other case reports of levofloxacin causing rhabdomyolysis in nondialysis or renal transplant recipients . Some of these cases were much more severe than ours, resulting in some of the poor outcomes of rhabdomyolysis, such as acute renal failure, anuria, metabolic acidosis, fatal hyperkalemia and compartment syndromes . However, to our knowledge, this is the first case of levofloxacin‐induced rhabdomyolysis in a hemodialysis patient.…”

Drug-induced myopathies

“…Rare cases have been described with ofloxacin [34], norfloxacin [35], and levofloxacin [36]. As in all cases of drug-induced rhabdomyolysis, discontinuation of the drug is mandatory.…”