Risk screening for long QT prior to prescribing levofloxacin

A 73-year-old woman presented to the emergency department with shortness of breath accompanied by a mild productive cough for 2 days. She had a history of end-stage renal disease, congestive heart failure, and hypertension. The initial diagnosis was early-onset health care-associated pneumonia and fluid overload. Therefore, a 750 mg levofloxacin was initiated intravenously (IV), and hemodialysis was arranged for the following day. Eight hours after admission to the emergency department, sudden-onset altered mental status and apnea occurred with an electrocardiogram showing polymorphic ventricular tachycardia, and torsade de pointes was obvious. The patient regained spontaneous circulation after cardioversion and was then admitted to the intensive care unit. This case reminds us of the potentially lethal adverse effects of IV levofloxacin. Patients who present with long QT should be evaluated for the risk of drug-induced torsade de pointes, including reviewing medical and drug history and a routine check of heart rate-corrected QT interval on electrocardiogram prior to prescribing IV levofloxacin.