Vol 9, No 2 (2020)
Case report
Published online: 2020-03-26

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

Anna Majda1, Paweł Rostoff1, Jadwiga Nessler1, Grzegorz Gajos1
Clin Diabetol 2020;9(2):141-143.

Abstract

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 μmol/L, estimated glomerular filtration rate 27 mL/min/1.73 m2). 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.

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