Current drug safety · 2026
Recognizing Subtle Neurological Adverse Effects of Fluoroquinolones: A Case Report of Isolated Dysarthria.
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Caroleo Benedetto, Marcianò Gianmarco, Bertucci Giuseppe, Caruso Marica, Di Masi Caterina, Fiorino Giovanni Antonio, Iacopino Remigio, Marra Francesco, Mitra Marilena, Pedace Elisabetta, Rania Vincenzo, Scumaci Domenica, Gallelli Luca
Аннотация
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.
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.