Tuberc Respir Dis.  2010 Dec;69(6):474-479.

Levofloxacin and Torsades de Pointes

• Kwon SA
• Kim CH
• Song WJ
• Koo JK
• Lee SJ
• Park JY
• Hyun IG
• Ko JH
• Kim HS

Abstract

Torsades de pointes associated with a prolonged QT interval is a life-threatening arrhythmia, which may be induced by any of the following: drugs, electrolyte imbalances, severe bradycardia and intracranial hemorrhage. Torsades de pointes is characterized by beat-to-beat variations in the QRS complexes in any ECG leads with rates of 200~250 per minute. Fluoroquinolones are widely used and well tolerated antibacterial agents. However, prolongation of the QT interval leads rarely to Torsades de pointes as a significant adverse effect. So, it should be used with caution in high-risk patients for developing Torsades de pointes. We report one case of 67-year old man with contact burns who experienced Torsades de pointes, which probably resulted from the use of levofloxacin, and no further episode occurred after its withdrawal.

Keyword

levofloxacin; Torsades de Pointes

MeSH Terms

Anti-Bacterial Agents
Arrhythmias, Cardiac
Bradycardia
Burns
Electrocardiography
Fluoroquinolones
Humans
Intracranial Hemorrhages
Ofloxacin
Torsades de Pointes
Anti-Bacterial Agents
Fluoroquinolones
Ofloxacin

Figure

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  Figure 1 A Photograph showed contact burns wound with skin defects in both foots.

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  Figure 2 Chest X-ray showed pulmonary edema and right pleural effusion at the 8th hospital day.

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  Figure 3 Torsades de pointes were initiated with prolonged QT interval.

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  Figure 4 Electrocardiogram during the use of levofloxacin. QT prolongation, T wave inversion and polymorphic ventricular tachycardia are noted.

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  Figure 5 Electrocardiogram after withdrawal of levofloxacin. Normal sinus rhythm was returned.

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  Figure 6 Chest X-ray showed marked improved pulmonary edema and pleural effusion at the 21st hospital day.

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  Figure 7 Bone marrow showed an increased number of plasma cells that were counted up to 6.2% of all nucleated cells (Wright- Giemsa stain, ×1,000).

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  Figure 8 Measuring of the corrected QT interval by Bazett formula (left, normal sinus rhythm; right, atrial fibrillation).

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