Via Research Recognition Day Program VCOM-Carolinas 2025

Case Reports

Extensor Digitorum Rupture Following Fluoroquinolone Use in an Elderly Patient with CKD Taylor Turner, OMS II 1 , Lindsay Tjiattas-Saleski, DO, MBA 2 . Edward Via College of Osteopathic Medicine – Carolinas Campus

Introduction

Figures

Diagnosis

Fluoroquinolone-induced tendon rupture is a rare but serious adverse effect associated with the use of fluoroquinolone antibiotics. This risk is particularly elevated in populations such as the elderly and those with renal impairment. The elderly are at increased risk due to age-related tendon degeneration, reduced elasticity, and decreased musculotendinous mass and strength. 1 Chronic kidney disease (CKD) further exacerbates this risk, as impaired renal clearance leads to prolonged exposure to fluoroquinolones. 2 CKD-related alterations in collagen synthesis, chronic inflammation, and oxidative stress may also contribute to tendon degeneration. 3,4 The consequences of delayed treatment for tendon ruptures can be severe, leading to chronic tendon instability, decreased range of motion, and reduced hand function due to tendon retraction, peritendinous adhesions, and/or fibrotic scar tissue development 5 A 72-year-old female presented to her primary care physician with inability to extend her right third digit. Symptoms began three weeks after completing a course of levofloxacin for a urinary tract infection. She reported sudden onset of symptoms, feeling a "pop" in her hand while opening a door, followed by pain, swelling, and erythema on the dorsum of her hand. Despite persistent symptoms, she delayed seeking medical attention for approximately one month. Her medical history included hypertension and Stage 3 chronic kidney disease (CKD). Physical examination revealed an observable deformity, extensor lag, and loss of extension in the right third digit. Ultrasound imaging demonstrated fibrosing scar formation and significant soft tissue edema, consistent with a tendon rupture. The observable deformity is illustrated in Figure 1. The ultrasound image is shown in Figure 2. Case Presentation

Closed rupture of the extensor digitorum communis tendon of the right third digit .

Discussion

Conclusion Conclusion Caution is necessary when prescribing fluoroquinolones to specific populations. Key takeaways include: • Consider alternative antibiotics for elderly patients with CKD • Educate patients on risks and importance of prompt evaluation Future research should focus on quantifying risks, exploring underlying mechanisms, and investigating optimal management strategies. Discussion • Impaired renal clearance and prolonged exposure • CKD-related alterations in collagen synthesis and oxidative stress • Age-related tendon degeneration Furthermore, delayed treatment can lead to chronic tendon instability and reduced hand function. This case highlights the increased risk of fluoroquinolone induced tendon rupture in elderly patients with renal impairment. Key contributing factors include:

Figure 1. Right hand of the patient demonstrating third-digit extensor lag and extension loss.

References

Figure 2. Ultrasound image revealing hypoechoic peri-tendinous edema (*) and a focal hypoechoic area consistent with fibrotic scarring of the extensor digitorum tendon (red arrow).

2025 Research Recognition Day

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