Case report
Pulmonary Embolism Associated with Spontaneous Bilateral Achilles Tendon Rupture

https://doi.org/10.1053/j.jfas.2007.03.014Get rights and content

Bilateral Achillies tendon ruptures are a rare occurrence that usually occur in patients with chronic systemic disease. Many cases are also associated with corticosteroid or fluoroquinolone use. Nonoperative treatment is generally indicated in this patient population, as the patients are often considered poor surgical candidates. Nonoperative immobilization, however, conveys the risk of developing deep venous thrombosis and pulmonary embolism. Such risks are even greater in patients displaying bilateral Achilles tendon ruptures. In this report, we illustrate the case of a near-fatal pulmonary embolism as associated with bilateral spontaneous Achilles tendon ruptures. We also review the current literature and make recommendations for prophylaxis and treatment of these potentially devastating complications.

Section snippets

Case Report

A 69-year-old man with a history of chronic obstructive pulmonary disease (COPD), asthma, and obstructive sleep apnea was admitted to the hospital for treatment of an acute exacerbation of his COPD. While in-house, he received intravenous corticosteroids and nebulizer treatments. He was discharged on a 60-mg tapered regimen of prednisone and a 10-day course of levofloxacin. Over the next 2 weeks, he developed bilateral posterior heel pain, and on day 17 after the exacerbation of his COPD, he

Discussion

Spontaneous tears account for about 1% of all Achilles tendon ruptures (9, 11) and are associated with an array of intrinsic and extrinsic risk factors. Intrinsic risk factors include prior trauma and degenerative changes of the tendon, and systemic disorders such as Cushing’s disease, rheumatoid arthritis (17), systemic lupus erythromatosus (18), hyperthyroidism, and gout. Extrinsic risk factors include pharmacologic agents such as corticosteroids (7, 9, 14, 19, 20, 21, 22) and

Conclusion

Bilateral Achilles tendon ruptures are rare and usually occur in patients with chronic disease, and many of these cases are associated with corticosteroid or fluoroquinolone use. Nonoperative treatment is generally effective for this population, and, despite eliminating risks associated with surgical repair of the tendon, immobilization therapy conveys the risk of developing DVT and pulmonary embolism. In the case of simultaneous, bilateral rupture of the Achilles tendon, the risk of DVT and

References (45)

  • L. Jozsa et al.

    The role of recreational sport activity in Achilles tendon ruptureA clinical, pathoanatomical, and sociological study of 292 cases

    Am J Sports Med

    (1989)
  • D.R. Baruah

    Spontaneous rupture of bilateral Achilles tendon of a patient on long-term systemic steroid therapy

    Unfallheilkunde

    (1984)
  • W. Dickey et al.

    Bilateral Achilles tendon rupture simulating peripheral neuropathy: unusual complication of steroid therapy

    J R Soc Med

    (1987)
  • S.F. Habusta

    Bilateral simultaneous rupture of the Achilles tendonA rare traumatic injury

    Clin Orthop Relat Res

    (1995)
  • J.F. Haines

    Bilateral rupture of the Achilles tendon in patients on steroid therapy

    Ann Rheum Dis

    (1983)
  • M. Kelly et al.

    Bilateral concurrent rupture of the Achilles tendon in the absence of risk factors

    Hosp Med

    (2004)
  • S. Orava et al.

    Bilateral Achilles tendon rupture: a report on two cases

    Scand J Med Sci Sports

    (1996)
  • V. Battista et al.

    Asynchronous bilateral Achilles tendon ruptures and androstenediol use

    Am J Sports Med

    (2003)
  • W.T. Lee et al.

    Ciprofloxacin associated bilateral Achilles tendon rupture

    Aust N Z J Med

    (1992)
  • A. Aroen et al.

    Contralateral tendon rupture risk is increased in individuals with a previous Achilles tendon rupture

    Scand J Med Sci Sports

    (2004)
  • K. Matsumoto et al.

    Rupture of the Achilles tendon in rheumatoid arthritis with histologic evidence of enthesitisA case report

    Clin Orthop Relat Res

    (1992)
  • I. Potasman et al.

    Multiple tendon rupture in systemic lupus erythematosus: case report and review of the literature

    Ann Rheum Dis

    (1984)
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