{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T20:38:12Z","timestamp":1792269492608,"version":"4.4.0"},"reference-count":14,"publisher":"BMJ","issue":"8","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,7,31]]},"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:p>Simultaneous bilateral atraumatic Achilles tendon rupture (SBATR) is an exceedingly rare clinical entity, accounting for less than 1% of all Achilles tendon injuries. Unlike unilateral traumatic ruptures, SBATR is often a sentinel marker of systemic toxicity or metabolic compromise. We report the case of a woman in her late 70s, a survivor of triple-negative breast cancer with a history of polymyalgia rheumatica and dyslipidaemia, who suffered spontaneous bilateral ruptures shortly after completing a course of fluoroquinolones (FQs) for respiratory sepsis. Her clinical baseline was characterised by chronic exposure to prednisone and simvastatin. Despite the severity of the structural failure, the patient was managed successfully with a functional conservative protocol.<\/jats:p>\n                  <jats:p>This case highlights the synergistic risk of tendon degradation when FQs are added to a baseline of corticosteroids, statins and a history of cytotoxic chemotherapy\u2014a \u2018pharmacological storm\u2019\u2014and demonstrates that non-operative management remains a viable and effective strategy in the geriatric population with multiple comorbidities.<\/jats:p>","DOI":"10.1136\/bcr-2026-274327","type":"journal-article","created":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T12:20:18Z","timestamp":1786969218000},"page":"e274327","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Simultaneous bilateral atraumatic Achilles tendon rupture in a breast cancer survivor: a fourfold pharmacological threat"],"prefix":"10.1136","volume":"19","author":[{"given":"Mart\u00edn","family":"Est\u00e9vez","sequence":"first","affiliation":[{"name":"Cirug\u00eda Ortop\u00e9dica y Traumatolog\u00eda, Hospital Universitario Severo Ochoa, Legan\u00e9s, Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hilario","family":"M\u00ednguez","sequence":"additional","affiliation":[{"name":"Cirug\u00eda Ortop\u00e9dica y Traumatolog\u00eda, Hospital Universitario Severo Ochoa, Legan\u00e9s, Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda Jos\u00e9","family":"Echarri","sequence":"additional","affiliation":[{"name":"Oncolog\u00eda M\u00e9dica, Hospital Universitario Severo Ochoa, Legan\u00e9s, Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,8,17]]},"reference":[{"key":"2026081705201324000_19.8.e274327.1","doi-asserted-by":"crossref","unstructured":"Habusta SF . Bilateral simultaneous rupture of the Achilles tendon. A rare traumatic injury. Clin Orthop Relat Res 1995;231\u20134.","DOI":"10.1097\/00003086-199511000-00036"},{"key":"2026081705201324000_19.8.e274327.2","doi-asserted-by":"publisher","DOI":"10.1086\/375078"},{"key":"2026081705201324000_19.8.e274327.3","doi-asserted-by":"crossref","first-page":"364","DOI":"10.1177\/03635465000280031401","article-title":"The effect of ciprofloxacin on tendon, paratenon, and capsular fibroblast metabolism","volume":"28","author":"Williams","year":"2000","journal-title":"Am J Sports Med"},{"key":"2026081705201324000_19.8.e274327.4","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/keg372"},{"key":"2026081705201324000_19.8.e274327.5","doi-asserted-by":"publisher","DOI":"10.2165\/00002018-200629100-00006"},{"key":"2026081705201324000_19.8.e274327.6","doi-asserted-by":"crossref","unstructured":"Fern\u00e1ndez-Cuadros ME , Casique-Bocanegra LO , Albaladejo-Flor\u00edn MJ , et al . Bilateral Levofloxacin-Induced Achilles Tendon Rupture: An Uncommon Case Report and Review of the Literature. Clin Med Insights Arthritis Musculoskelet Disord 2019;12. doi:10.1177\/1179544119835222","DOI":"10.1177\/1179544119835222"},{"key":"2026081705201324000_19.8.e274327.7","article-title":"Surgical Repair of Bilateral Achilles Tendon Rupture Following Levofloxacin Use","volume":"17","author":"Anderson","year":"2025","journal-title":"Cureus"},{"key":"2026081705201324000_19.8.e274327.8","doi-asserted-by":"crossref","first-page":"492","DOI":"10.3109\/07853890.2015.1074272","article-title":"Oral and inhaled glucocorticoid use and risk of Achilles or biceps tendon rupture: a population-based case-control study","volume":"47","author":"Spoendlin","year":"2015","journal-title":"Ann Med"},{"key":"2026081705201324000_19.8.e274327.9","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.324.7349.1306"},{"key":"2026081705201324000_19.8.e274327.10","doi-asserted-by":"crossref","DOI":"10.1186\/1752-1947-5-263","article-title":"Bilateral spontaneous non-traumatic rupture of the Achilles tendon: a case report","volume":"5","author":"Khanzada","year":"2011","journal-title":"J Med Case Rep"},{"key":"2026081705201324000_19.8.e274327.11","doi-asserted-by":"publisher","DOI":"10.1016\/j.tox.2013.06.010"},{"key":"2026081705201324000_19.8.e274327.12","doi-asserted-by":"crossref","unstructured":"Kwak D , Moon SJ , Park JW . Effects of Statin Treatment on the Development of Tendinopathy: A Nationwide Population-Based Cohort Study. 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