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.