Ciprofloxacin Induced Achilles Tendinopathy

Abstract

HISTORY: 26 year old college graduate student with past medical history of a kidney stone had painful urination and increased frequency over several days. He was seen by internist at student health center, prescribed Ciprofloxacin for 14 days for acute bacterial prostatitis. Two months later he developed right Achilles tendon pain which had started insidiously upon awakening one morning, with no inciting event except for taking Ciprofloxacin 6 weeks earlier. PHYSICAL EXAMINATION: Swelling of the of posterior ankle noted. Tenderness to palpation at the insertion site of a tight Achilles tendon was appreciated. DIFFERENTIAL DIAGNOSIS: 1. Ciprofloxacin induced Achilles tendinopathy 2. Idiopathic Achilles tendinopathy 3. Postraumatic Achilles tendinopathy TEST AND RESULTS: 1. Ankle ultrasonography: Thickening and swelling of Achilles tendon. 2. Ankle X-tray: No bony abnormalities. FINAL WORKING DIAGNOSIS: Ciprofloxacin Induced Achilles Tendinopathy TREATMENT AND OUTCOMES: 1. Walking boot 2. NSAIDs 3. Physical therapy. Patient has recovered after six month of treatment.