Levofloxacin-induced life-threatening hypoglycemia in a type 2 diabetic patient with ST-segment elevation myocardial infarction and community-acquired pneumonia

摘要

Levofloxacin is a broad-spectrum, third-generation fluoroquinolone antibiotic used in the treatment of respiratory and urinary tract infections. Although it is usually well-tolerated, it may cause life-threatening adverse effects, including severe hypoglycemia. We present a case of levofloxacin-induced life-threatening hypoglycemia in a 87-year-old type 2 diabetic patient with ST-segment elevation myocardial infarction and community-acquired pneumonia. Hypoglycemia secondary to levofloxacin is a rare complication (< 0,1%), but can be more common among elderly patients, with type 2 diabetes (especially treated with hypoglycemic drugs) or renal dysfunction. Our patient was at high risk due to age, diabetes and chronic kidney disease (creatinine 149 mu mol/L, estimated glomerular filtration rate 27 mL/min/1.73 m(2)). In the Naranjo probability scale, the patient scored 5 points, which indicates that hypoglycemia was a probable levofloxacin-related adverse effect. In conclusion, we suggest that levofloxacin should be used with greater caution, particularly in patients at increased risk of hypoglycemia.