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Acute Rhabdomyolysis Associated with Ofloxacin/Levofloxacin Therapy

Clinical Pharmacist, Department of Pharmacy, National Cheng Kung University Hospital, Taiwan, Republic of China

Chia-Ming Chang, MD

Clinical Specialist in Infection, National Cheng Kung University Hospital

Chao-Jung Tsao, MD PhD

Professor of Internal Medicine, College of Medicine, National Cheng Kung University

Yu-Yun J Lee, MD PhD

Professor of Dermatology, College of Medicine, National Cheng Kung University

May-Ying Hsu, MSc (Pharm)

Clinical Pharmacist, Department of Pharmacy, National Cheng Kung University Hospital

Ta-Jen Wu, MD

Associate Professor of Internal Medicine, College of Medicine, National Cheng Kung University

Reprints: Dr. Wu, College of Medicine, National Cheng Kung University, 138 Sheng-Li Rd., Tainan 704, Taiwan, R.O.C., fax 886-6-276-6175, djwu{at}mail.ncku.edu.tw

OBJECTIVE: To report a case of ofloxacin/levofloxacin-induced rhabdomyolysis and to compare other reported cases from the literature.

CASE SUMMARY: A 19-year-old male patient developed ofloxacin/levofloxacin-induced rhabdomyolysis during admission for periorbital cellulitis. Symptoms of myalgia, weakness, and swelling of the arms developed after 3 days of treatment with ofloxacin 800 mg/day. Laboratory analysis confirmed the presence of urine myoglobin (381.2 µg/L) and a marked increase in serum myoglobin (590.8 µg/L), along with marked elevations in serum creatine kinase (up to 16 546 IU/L).

DISCUSSION: In addition to ruling out other possible etiologic factors one by one, we assessed the probability of ofloxacin/levofloxacin-induced rhabdomyolysis by observing the close time relationship between drug administration and the development of symptoms/signs, as well as the close time relationship between drug withdrawal and the disappearance of symptoms/signs. An objective causality assessment by use of the Naranjo probability scale revealed that the adverse drug reaction was probable.

CONCLUSIONS: Although ofloxacin/levofloxacin-induced rhabdomyolysis appears to be rare, patients with muscle pain, swelling, or weakness during therapy should be closely monitored for this adverse effect.

Key Words: levofloxacin, ofloxacin, rhabdomyolysis

Published Online, November 23, 2004. www.theannals.com, DOI 10.1345/aph.1E285