A rare cause of pulmonary infiltrates one should be aware of: a case of daptomycin-induced acute eosinophilic pneumonia

Abstract

We report a 69-year-old patient who developed fever and dyspnea 3 weeks after the initiation of daptomycin therapy for spondylodiscitis with lumbar epidural and bilateral psoas abscesses due to ampicillin- and high-level-gentamicin-resistant Enterococcus faecium. There was profound hypoxia and the chest X-ray showed extensive patchy infiltrates bilaterally. A bronchoalveolar lavage revealed 30% eosinophils and results of microbiological studies were normal. Daptomycin-induced eosinophilic pneumonia was diagnosed and the patient rapidly improved after the discontinuation of daptomycin and a brief course of prednisone. Increased attention must be paid to this rare but serious side effect of daptomycin.

Daptomycin-induced eosinophilic pneumonia - a systematic review

“…Details regarding the 38 possible cases reported through AERS were not described. Of the 20 cases that were identified as definite or probable, 9 have been published in the literature, the remaining 11 were summarized by Kim [1, 3, 9–13]. We also identified 39 additional cases of eosinophilic pneumonia attributed to daptomycin for a total of 59 cases described in the literature [7, 14–24].…”

“…In addition, since some patients had BAL < 25% eosinophils but lung biopsy revealed eosinophilia [1, 13], a 25% cut off may be too strict in certain situations.…”

Experience with daptomycin daily dosing in ICU patients undergoing continuous renal replacement therapy

“…In our ICU, daptomycin is used in patients with contraindication to standard antibiotic therapy with glycopeptides due to its low nephrotoxic potential. Although very rare cases of acute eosinophilic pneumonia have been reported [2], its dose-dependent toxicity is limited to creatine kinase elevation with rare cases of rhabdomyolysis [3]. Daptomycin is a lipopeptide antibiotic active against Gram-positive organisms, including methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant pathogens.…”

Myopathy and Eosinophilic Pneumonia Coincidentally Induced by Treatment with Daptomycin

“…In order to clarify the clinical characteristics of DAP-induced EP, we performed a literature review. Consequently, the data for 25 previous cases and the present case are summarized in the Table (8,(17)(18)(19)(20)(21)(22)(23)(24)(25)(26). The average age of the patients was 64 years (range: 26 to 87 years), and men were predominant (88%, 22 of 25 patients).…”