A Tale of a Drug That Killed a Bug but Caused Pneumonia: A Case Report of Daptomycin Induced Eosinophilic Pneumonia

Document Type

Conference Proceeding

Publication Date

5-21-2023

Publication Title

Am J Respir Crit Care Med

Abstract

Acute eosinophilic pneumonia (AEP) is dramatic in presentation mimicking infectious pneumonia or acute respiratory distress syndrome in previously healthy individuals. Medications are a recognized cause of AEP. Daptomycin, a lipopeptide antibacterial agent has been strongly linked to AEP. Clinicians should maintain a high index of suspicion for drug induced AEP in patients being treated with daptomycin who develop respiratory distress. We present a case of a patient with a septic joint treated with Daptomycin who developed AEP. Patient is an 80 year old man with hypertension, hypothyroidism, atrial flutter, complete heart block s/p pacemaker, who had a mucinous cyst on his left index finger, requiring hospitalization. Blood cultures grew MRSA s/p debridement of the joint. He was discharged on intravenous Daptomycin. Two weeks after being discharged he presented with fevers, fatigue and dyspnea. Temperature was 103.8 and Oxygen saturation was 90% on 2L NC. WBC count was 8.6 with no eosinophilia. ESR 110, negative blood cultures, sputum cultures with commensal flora, negative urine legionella, PCR for SARS COV-2 was negative and lactic acid was 1.5. Chest radiograph showed mild interstitial airspace disease in the left mid and lower thorax, and small bilateral pleural effusions. CT chest showed scattered bilateral consolidations and ground glass opacities and trace bilateral effusions. Daptomycin was switched to Vancomycin. Patient's oxygen requirements increased to 6l NC. Patient underwent bronchoscopy with broncheoalveolar lavage revealing inflamed bronchial mucosa with copious secretions. BAL showed 45% eosinophils, with negative gram stain and culture. Patient was started on methylprednisolone 60 mg four times every day and then tapered. Vancomycin was switched to oral Linezolid. Patient's hypoxia improved and was discharged home on 3l NC. At four weeks follow up, he no longer required oxygen on ambulation and chest radiograph showed complete resolution of infiltrates. Over 140 drugs have been recognized as a cause of drug induced eosinophilic pneumonia (DIEP). The diagnosis of DIEP requires febrile illness <5 days, diffuse bilateral infiltrates, hypoxemia and BAL showing >25% eosinophils or eosinophilic pneumonitis on lung biopsy. Additionally, a diagnosis of DIEP requires exposure to a candidate drug in the appropriate time frame, exclusion of infectious causes of eosinophilic pulmonary opacities and clinical improvement after cessation of medication. In 2010 US FDA issued a warning about the risk of developing eosinophilic pneumonia during treatment with Daptomycin. Clinicians should maintain a high index of suspicion for DIEP in patients treated with Daptomycin who develop respiratory distress.

Volume

207

Issue

1

First Page

A3187

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