Myopathy and Eosinophilic Pneumonia Coincidentally Induced by Treatment with Daptomycin

Hagiya, Hideharu; Hasegawa, Kou; Asano, K.; Terasaka, Tomohiro; Kimura, Kosuke; Nada, Takahiro; Nakamura, Eri; Waseda, Koichi; Hanayama, Yoshihisa; Otsuka, Fumio

doi:10.2169/internalmedicine.54.3397

Cited by 13 publications

(3 citation statements)

References 33 publications

(34 reference statements)

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“…Interest-ingly, 3 cases reported the onset of daptomycin-induced AEP shortly after the third day of exposure but actually all patients had been previously exposed to daptomycin, suggesting a priming immunologic effect. Hagiya et al [95] reported a case of patient who developed AEP after the third day of daptomycin administration. This very short treatment regimen was in fact a re-exposure for the patient, being the primary challenge 20 days earlier [95].…”

Section: Discussionmentioning

confidence: 99%

“…Hagiya et al [95] reported a case of patient who developed AEP after the third day of daptomycin administration. This very short treatment regimen was in fact a re-exposure for the patient, being the primary challenge 20 days earlier [95]. Zimmer et al [105] reported a similar case, in which the patient presented a daptomycin-induced AEP with sudden respiratory distress 9 days after a 3-day re-challenge of daptomycin, 2 weeks after priming.…”

Section: Discussionmentioning

confidence: 99%

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Daptomycin-Induced Eosinophilic Pneumonia: A Case Report and Systematic Review

Di Lorenzo,

Rindi,

Campogiani

et al. 2023

Chemotherapy

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Introduction Acute eosinophilic pneumonia (AEP) is a rare respiratory condition caused by eosinophil accumulation in the pulmonary tissue that can be related to drug administration. Daptomycin, an antibiotic active against gram-positive bacteria, is one of the leading causes of AEP among drugs. In order to raise awareness of this rare syndrome, in our work we have described a case of an 82 years-old male with Enterococcus faecalis endocarditis treated with daptomycin, who developed a daptomycin-induced AEP. We have performed a systematic review of the literature for all similar reported cases. Methods The systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. To conduct the analysis, the terms “daptomycin AND eosinoph* AND pneum*”, were entered the databases Medline, Cinahl and Embase on April 13th, 2023. We considered relevant all records documenting AEP after daptomycin use. No restrictions in terms of year or language were made. A formal appraisal of observational studies was performed by Newcastle-Ottawa Scale. All results and data were reported by means of tables. Results Our search identified 93 relevant records, published between 2007 and 2023. A total of 120 patients were considered. Patients who experienced AEP were mostly males (n=88, 73.3%) with a mean age of 68.28 years (SD11.54). Daptomycin was most frequently prescribed for osteoarticular infections (n=75, 62.5%) and to treat gram-positive cocci infections. The most frequently isolated pathogen was Methicillin-resistant Staphylococcus aureus (MRSA). Daptomycin was mostly used with off-label indications (n=89, 74%). Symptoms of AEP were usually reported after a mean of 21.75 days of treatment (range 3-84) and typically included fever, dyspnea, dry cough and acute respiratory failure. Reported treatment strategies invariably included daptomycin withdrawal, respiratory support, and corticosteroid treatment. One hundred and sixteen patients fully recovered. A fatal outcome was described in 4 patients. Suggestive symptoms and imaging raised suspicion for AEP, confirmed with bronchoalveolar lavage in 57.5% of the cases. Discussion and Conclusions Daptomycin-induced AEP is a rare but potentially fatal complication, mostly reported after long treatment with daptomycin. Clinicians should be aware of this syndrome, as it could be initially misdiagnosed for an acute infectious respiratory syndrome, resulting in a delay in its diagnosis and treatment. Furthermore, since the risk of developing AEP is increased by longer drug exposure, caution should be used when discussing the use of daptomycin in longer treatment regimens.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Daptomycin-Induced Eosinophilic Pneumonia: A Case Report and Systematic Review

Di Lorenzo,

Rindi,

Campogiani

et al. 2023

Chemotherapy

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“…Dyspnea was the most common documented symptom associated with eosinophilic pneumonia followed by the presence of either pulmonary infiltrates or opacities on chest x-ray or CT [2] . Both of our patients had dyspnea and pulmonary infiltrates on the CT, but EP patients might present with fever in the absence of respiratory symptoms [5] , [10] , [11] . EP may or may not be associated with peripheral blood eosinophilia, however pulmonary eosinophilic infiltrates or BAL eosinophilia are the corner stone for the diagnosis of EP.…”

Section: Discussionmentioning

confidence: 99%

Two patients with daptomycin induced eosinophilic pneumonia with different presentations and treatment

Raru

Zeid

Browning

et al. 2018

Respiratory Medicine Case Reports

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We present two cases of daptomycin-induced eosinophilic pneumonia with characteristic chest x ray, CT scan and bronchoalveolar lavage (BAL) findings. It is not a commonly seen complication of Daptomycin but when it happens, it could cause a diagnostic and treatment dilemma. Patients could present acutely with hypoxic respiratory failure or a less dramatic chronic presentation is also possible. Our two patients presented with acute hypoxic respiratory failure and presentation resembles that of an infectious etiology. Diagnosis is confirmed by bronchoscopy with BAL in one of them and the other was treated empirically as the clinical and radiologic presentation was typical. Treatment includes removal of the offending agent, daptomycin. Corticosteroids are used if symptoms are severe and can result in rapid clinical improvement. There is no agreed upon dose and duration of steroids and we suggest a long taper of steroids for patients who present with severe symptoms and a short course steroid for patients with milder symptoms.

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