Levofloxacin and rhabdomyolysis in a renal transplant patient
Abstract
Rhabdomyolysis can lead to fatal hyperkalaemia, acute renal failure and compartment syndromes in renal transplant patients. The most common cause for rhabdomyolysis in these patients is a drug interaction between statins and ciclosporin A [ 1 ]. Statins are known to be myotoxic [ 2 ], and their serum levels can be elevated with the concomitant use of ciclosporin A, as the metabolism of both drugs is dependent on the 3A4 coenzyme of the cytochrome P450 system. Some argue that the safest statins for transplanted patients are those whose elimination is independent of the P450 system, e.g. pravastatin. Flouroquinolones have become widely used antibiotics. In this report, levofloxacin led to rhabdomyolysis in a renal transplant patient. Although scattered reports are beginning to appear showing that these agents can induce rhabdomyolysis [ 3–5 ], this is the first such description of a possible levofloxacin–induced rhabdomyolysis in a renal transplant recipient. A 68-year-old man was admitted with a 3-day history of fever and cough. Past medical history included a first, cadaveric-donor, renal transplant in 1980. In 1994, the patient received a second, cadaveric-donor, renal transplant. Dual immunosuppression was maintained with prednisone and ciclosporin A. Renal function was stable, with a glomerular filtration rate (GFR) (MDRD) ∼30 cc/min/1.73 m 2 . Ischaemic heart disease required coronary artery bypass grafts in 1993, and recurrent gouty arthritis was treated with…
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