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Abstract We report a case of spontaneous Achilles tendon rupture associated with myeloperoxidase anti-neutrophil cytoplasmic antibody (MPO-ANCA)-related microscopic polyangiitis in a 77-year-old man who was treated with oral corticosteroids. Several days after 10 days of treatment with levoflaxacin (daily dose 200 mg) for bacterial pneumonia, he noted discomfort around both Achilles tendons. The discomfort developed into swelling around his left ankle, and he could not walk well. We diagnosed bilateral Achilles tendinitis with spontaneous rupture induced by levofloxacin. Epidemiological studies show that the risk of fluoroquinolone-related tendon rupture is highest among patients over the age of 60 years who are receiving a corticosteroid. Rupture of the Achilles tendon is a rare but serious side effect of fluoroquinolone usage. Thus, physicians should be aware of this adverse effect, especially when prescribing medication for aged patients being treated with corticosteroids.