eng Science and Education Publishing American Journal of Medical Case Reports 2374-216X 2020-12-18 9 2 122 124 10.12691/ajmcr-9-2-6 AJMCR2021926 article Hussam Alkaissi 1 Srinivas Kolla 2 Cameron Page 2 Latif Salam 2 Moro O. Salifu 2 Isabel M. McFarlane Isabel.McFarlane@downstate.edu 2 Department of Internal Medicine, State University of New York, Downstate Health Sciences University, Brooklyn, NY 11203, USA Department of Radiology, State University of New York, Downstate Health Sciences University, Brooklyn, NY 11203, USA Fluoroquinolones are antimicrobial agents that inhibit bacterial DNA synthesis by binding to DNA gyrase and DNA topoisomerase IV. Fluoroquinolones have also been associated with the development of tendinopathy, tendon rupture, and arthropathy. The postulated mechanisms for quinolone-associated tendinopathy are alteration of the tendon extracellular matrix, impairment of tenocyte proliferation, and enhanced apoptosis due to the quinolone cation chelation properties. We present a case of a man who developed multiple tears of the rotator cuff after exposure to levofloxacin. Although marketed quinolones are well tolerated, adverse events involving gastrointestinal, cardiovascular, neurological, and tendinopathy and at-risk patient populations should be kept in mind by clinicians. http://pubs.sciepub.com/ajmcr/9/2/6/ajmcr-9-2-6.pdf fluoroquinolone tendinopathy rotator cuff