Ciprofloxacin-induced tendinopathy of the gluteal tendons

Abstract

Fluoroquinolone-induced tendinopathy most commonly affects the Achilles tendon; however, involvement of several other tendons has been described. This is a case report of ciprofloxacin-induced tendinopathy of the gluteal tendons with MRI findings. An obese 25-year-old woman with no significant past medical history was diagnosed with acute pyelonephritis and was treated with intravenous ciprofloxacin. Shortly after her first dose of ciprofloxacin, she developed severe left hip pain and decreased range of motion. MRI of the hips showed bilateral tendinopathy of the gluteal muscle insertion. A diagnosis of ciprofloxacin-induced tendinopathy was made based on her MRI and a Naranjo score of 7. Ciprofloxacin was stopped and her pain quickly resolved. Fluoroquinolones cause tendinopathy in 0.14 % to 0.4 % of patients using these agents. Fluoroquinolone-associated tendinopathy is a serious adverse reaction that can affect many tendons and should be considered in any patient presenting with new musculoskeletal complaints and in whom there is a history of fluoroquinolone use within the preceding 6 months.

Figure 1

Coronal T2-weighted MRI of hips demonstrating abnormal fluid signal at the distal gluteus medius and gluteus minimus tendon attachments (arrows).

Figure 2

Axial T2-weighted MRI of hips demonstrating fluid tracking along the distal insertions of the gluteus medius and gluteus minimus tendons with more involvement on the left (arrows).

Figure 3

Naranjo algorithm (designed by Naranjo et al., adapted by Doherty, M.). This figure was published in Respiratory Medicine CME, vol 2, Martin J. Doherty, Algorithms for assessing the probability of an adverse drug reaction, pp 63-67, copyright Elsevier (2009).