Recognizing Subtle Neurological Adverse Effects of Fluoroquinolones: A Case Report of Isolated Dysarthria
Abstract
BACKGROUND
Fluoroquinolones may have negative effects on the central nervous system; isolated dysarthria has not been thoroughly described.
CASE
Piperacillin/tazobactam and high-dose levofloxacin were used to treat a severe case of Legionella pneumophila pneumonia in a 55-year-old man with diabetes and temporary renal failure who was admitted to the hospital. On the eighth day of treatment, he experienced sudden dysarthria without any additional neurological impairment. Magnetic resonance angiography and brain magnetic resonance imaging results were negative. After levofloxacin was stopped two days later and replaced with azithromycin, the patient's dysarthria completely disappeared, and he was discharged on azithromycin (500 mg for 11 days). The Naranjo score (likely adverse reaction) was 6.
CONCLUSION
This case report highlights the importance of quickly identifying even mild neurological problems in fluoroquinolone-treated patients, especially when risk factors are present. In a broader sense, it upholds the concepts of patient safety and therapeutic appropriateness, which state that drugs should only be used when necessary and should be stopped immediately if they have negative side effects. In this regard, strict adherence to the current regulatory cautions about fluoroquinolones is necessary.
How strong is the evidence?
Evidence Hub reads this as a case report, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health.
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