SHM Converge Scientific Abstract ePoster Gallery-Levofloxacin Shakes: Case Presentation of Fluoroquinolone-Induced Myoclonus

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This case report describes an 87-year-old woman with multiple comorbidities, including chronic kidney disease and diabetes, who developed acute bilateral arm shaking, facial twitching, and later leg jerking with difficulty walking, shortness of breath, and nausea after receiving three doses of levofloxacin for a urinary tract infection. She was initially thought to be in status epilepticus and received lorazepam without improvement. Neurology noted non-rhythmic, low-amplitude twitching that worsened with talking and arm extension, leading to suspicion of levofloxacin-induced myoclonus. Her symptoms resolved within 48 hours after levofloxacin was stopped and replaced with piperacillin-tazobactam.<br /><br />The abstract emphasizes that fluoroquinolones are associated with several serious adverse effects, including central nervous system toxicity, peripheral neuropathy, tendon injury, and cardiotoxicity. Although prescribing has declined since the FDA boxed warning, inappropriate use remains common. Myoclonus is a rare but important neurologic adverse reaction, and available literature suggests it occurs more often in patients with renal or hepatic dysfunction.<br /><br />A key point is that levofloxacin clearance is significantly reduced in renal impairment, extending its half-life from about 6–8 hours in healthy adults to 27–35 hours in those with kidney dysfunction. Dose reduction is recommended when GFR is below 50 mL/min, with further adjustment at very low GFR. Because the patient had CKD and diabetes, she was at increased risk for toxicity and may not have had adequate renal dose adjustment.<br /><br />The authors conclude that clinicians should reduce unnecessary fluoroquinolone prescribing and carefully adjust doses in patients with impaired kidney function to prevent neurologic adverse events such as myoclonus.

Asset Subtitle

Nicole M. Leonick

Meta Tag

Author List Andrew G. Ajemian, Nicole M. Leonick

Category Clinical Vignettes

Concept Fluoroquinolone Adverse Reaction

Concept Central Nervous System Toxicity

Concept Myoclonus

Concept Levofloxacin

Concept Renal Dose Adjustment

Distinguished Non-Finalist

Presenter Organization Cooper Medical School of Rowan University

Presenting Author Nicole M. Leonick

Track Adult

Keywords

levofloxacin

myoclonus

fluoroquinolone toxicity

renal impairment

chronic kidney disease

central nervous system toxicity

urinary tract infection

dose adjustment

elderly patient

neurologic adverse event

Fluoroquinolone Adverse Reaction

Central Nervous System Toxicity

Myoclonus

Levofloxacin

Renal Dose Adjustment