Case presentation:
74-year-old male with past medical history of obstructive sleep apnea, GERD presented with pain in left hip for 2 days. It was preceded by a pop felt while lifting a heavy steel bar. Two months prior to this he was treated for bronchitis with prednisone and levofloxacin, but the course was cut short a week into treatment as the patient developed pain in his right ankle, right shoulder and left hip. Physical examination was significant for tenderness of left hip; tenderness and palpable dell right Achilles. MRI revealed a full thickness tear of left iliopsoas tendon (Figure 1, 2) and right Achilles tendon (Figure 3), as well as a low-grade partial tear of right semimembranosus tendon origin (Figure 4). Patient was managed conservatively. He was recommended to weight bear as tolerated, continue physical therapy and follow up closely with orthopedics. Fluoroquinolones mediated tendinopathy commonly affects weightbearing joints which are subjected to greater mechanical force.1 Nearly 90% of fluoroquinolone-associated tendinitis and tendon rupture cases involve the Achilles tendon with bilateral involvement in up to 50% of cases. 2 To our knowledge our case is first reported case of concomitant full thickness Achilles and Iliopsoas, and partial semimembranosus tendon rupture.