A 17yo male marriage with uneventful previous history developed generalised myalgias, exercise intolerance, and general fatigue after two dosages of azithromycin (500mg/d) during 3d for febrile infection. Neurologic exam revealed generally reduced tendon reflexes. Serum creatine-kinase was elevated to 25000U/L. Needle-EMG showed short and small, polyphasic motor-units and abnormal spontaneous activity, being interpreted as myositis. Azithromycin was discontinued and he was advised to avoid the fitness studio and to drink plenty of liquids. Myalgias disappeared within two days and CK continuously declined. Azithromycin may trigger rhabdomyolysis in the context of exercise and infection. Azithromycin may be myotoxic why it should be prescribed with caution in exercising and infected patients.

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Though neurological/ophthalmologic side effects in form of headache, vertigo, somnolence, paresthesias, optic neuritis and optic neuropathy are listed as side effects in the leaflet, transient tube-seeing and unconsciousness after a single dose of ibuprofen have not been reported. The patient is a 48yo male who experienced sudden-onset tube-seeing for a few seconds, followed by unconsciousness for 20 minutes, during which he was communicating with his boss in a tipsy way, 15 minutes after having taken 200mg ibuprofen. After awakening, it took 2-3h to regain his premorbid condition. There was no tongue biting or secessus. Since blood pressure, blood tests, blood gas analysis, ECG, and EEG were normal and cerebral MRI only showed non-specific spots in the subcortical white matter, the condition was attributed to ibuprofen. This case shows that a single dose of ibuprofen may cause severe side effects in the form of tube-seeing and unconsciousness. Ibuprofen should be given with caution as single dosages may cause severe side effects.