DOI: 10.36347/sajb.2017.v05i01.008

Pages: 32-35

Quinolones are family of broad spectrum antibiotics effective for both gram positive and gram negative bacteria. They have important roles in the treatment of many refractory infections like, hospital acquired infections, multi drug resistant tuberculosis etc. In 2008, a boxed warning was ordered by FDA on quinolones which have been associated with the causation of tendon rupture and tendinitis. Achilles tendon is the most common tendon affected. Tendinopathy involving supraspinatus and other rotator cuff muscles are very rare. Our case is a 54 year old female presented with insidious onset of pain and restricted movements of right shoulder of two weeks duration. She is a known case of multi drug resistant pulmonary tuberculosis. She is on continuation phase therapy for the same with moxifloxacin, linezolid, clarithromycin and ethambutol. Her last BAL sample culture was negative for tuberculosis three months back. There were no features of infection. MRI of right shoulder revealed supraspinatus tendinosis and myositis of rotator cuff muscles. As no other etiology could be postulated for the shoulder pain, this is most probably due to drug induced tendinopathy and associated myositis due to moxifloxacin. Moxifloxacin was stopped and she was treated with rest, physical therapy and supportive measures. Patient started improving clinically and radiologically. Tendinopathy is a known side effect of quinolones, but drug induced tendinopathy affecting supraspinatus and other rotator cuff muscles is a rare entity. Physicians should be aware about this known complication to reduce the associated morbidity and rupture, by early diagnosis and treatment.