A 68-year-old man on long-term prednisolone for polymyalgia rheumatica is started on levofloxacin. Ten days later he presents with sudden calf pain and inability to bear weight; imaging confirms an Achilles tendon tear. Which additional serious adverse effect belongs to the same class-wide boxed warning issued for systemic fluoroquinolones?
- A Aortic aneurysm and dissection ✓
- B Hepatic veno-occlusive disease
- C Progressive multifocal leukoencephalopathy
- D Pulmonary fibrosis
Correct answer: A. Aortic aneurysm and dissection
Explanation
Regulatory authorities have issued class warnings for systemic fluoroquinolones covering disabling adverse effects: tendinitis and tendon rupture, peripheral neuropathy, CNS effects, QT prolongation, dysglycemia, exacerbation of myasthenia gravis, and aortic aneurysm and dissection. Elderly patients on corticosteroids carry the highest tendon risk. Hepatic veno-occlusive disease is linked to pyrrolizidine alkaloids and busulfan, and pulmonary fibrosis to amiodarone and bleomycin.
Reference: Goodman and Gilman's The Pharmacological Basis of Therapeutics, 14th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.