Acute rhabdomyolysis associated with ofloxacin/levofloxacin therapy

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 mug/L) and a marked increase in serum myoglobin (590.8 mug/L), along with marked elevations in serum creatine kinase (up to 16546 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.