Fluoroquinolone use preceding medium-size artery dissection: A case series

Fluoroquinolones (FQ), commonly prescribed antibiotics, may trigger aortic dissection and carotid dissection to a lesser extent. To report dissection of medium-size artery following FQ treatment. From January 1st, 2020, to December 31st, 2021, 98 patients with one or several visceral artery dissection or aneurysm have been enrolled in the NEVADA cohort (Next Event after Visceral Artery Dissection or Aneurysm) of the vascular department, Georges-Pompidou European hospital, Paris. Among them, 3 patients received FQ within six months before the dissection. One patient had a celiac trunk dissection (Fig. 1), and two patients had a dissection of the superior mesenteric artery. These events occurred up to 4 months after 7 to 14 days of FQ treatment (2 cases of ofloxacin, 1 of norfloxacin). There was no other obvious cause of dissection. These dissections were isolated, apart from a minimal aortic dissection and separate from the visceral arterial dissection. In addition to the well-recognized risk of aortic dissection following FQ use, visceral arterial dissection should also be considered if abdominal pain occurs, as it is likely in our case series. To our knowledge, it is the first case series reporting visceral artery dissections following a treatment by FQ. All the previous studies establishing a link between arterial dissection and FQ were related to aortic syndrome or carotid arteries. Although this class of antibiotics is effective to treat many infectious diseases, their prescription must be earmarked for weighed medical indications and avoided in patients with a previous history of dissection or underlying condition of arterial fragility. In addition, the search for a fluoroquinolone intake must be carried out precisely in the event of the discovery of a medium-sized arterial dissection.