Fluoroquinolone-induced serious, persistent, multisymptom adverse effects, Golomb et al, 2015
"A 46-year-old man in vigorous good health, employed in a physically demanding, high responsibility job, was treated with 750 mg/day levofloxacin for 21 days for an unconfirmed diagnosis of epididymitis; during treatment, low-grade muscle aches and pains newly emerged. Muscle aches continued following FQ discontinuation, with progression and emergence of symptoms including fatigue, muscle weakness and atrophy, peripheral neuropathic and autonomic disturbances (tachycardia, bradycardia), CNS manifestations (cognition and mood), vision abnormalities, with gastrointestinal manifestations and intestinal motility issues. Initially, after FQ use, he experienced what he termed an ‘autonomic storm’ comprising tachycardia, accompanied by very low energy, depression and anxiety. His symptoms evolved with tendinopathy emerging at 9 months affecting the Achilles tendons, feet and knees, and producing tendon pain with exercise in an athlete who previously ran or biked 10 miles a day. Limitations due to pain, and later fatigue, progressed, necessitating progressive curtailing of his cycling from 10 to 6, 4, 3 then 0 miles/day.
He switched to walking, which then also became difficult. He purchased an exercise cycle in an effort to remain active, but discontinued use, as aerobic exercise produced delayed fatigue and pain. He stated, “I would expend energy and then pay for it later.” Bilateral patellar and foot tendon as well as knee pain with walking emerged, requiring him to stop and sit after walking 100 feet.
Muscle strength seemed initially relatively preserved (compared to sustained activities—eg, he could open jars that his wife found problematic), but 15–30 min after application of effort he would experience significant fatigue, and muscle strength deteriorated with time."
