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Osteonecrosis of the jaw, eosinophilia and frequent asthma exacerbations: case report A man in his 30s [exact age at event onset not stated] developed osteonecrosis of the jaw following treatment with prednisone for hyper-IgE syndrome. Later, he developed eosinophilia during treatment with daptomycin, and eosinophilia with associated frequent asthma exacerbations during treatment with vancomycin for the treatment of osteonecrosis of the jaw [not all routes and dosages stated; durations of treatments to reactions onsets and outcomes not stated]. The man, who had asthma, was managed with salbutamol [albuterol] and salmeterol/fluticasone-propionate [fluticasone/ salmeterol]. He also had hyper-IgE syndrome, for which he received treatment with oral prednisone. Subsequently, he was noted with osteonecrosis of the jaw. The symptoms of osteonecrosis of the jaw were present for the past 18 months. Diagnostic imaging showed an infectious process, and the development of osteonecrosis of the jaw was considered as secondary to the frequent use of prednisone for hyper-IgE syndrome. Hence, the man’s treatment was started with vancomycin infusions, which was administered as inpatient or at an outpatient infusion center. During the vancomycin treatment, he required frequent hospital admission (18 times) due to acute exacerbations of asthma. The baseline eosinophil count was noted as 0%, but a gradual increase in the eosinophil count was noted at the time of each admission. Approximately 1 year after the start of vancomycin therapy, he underwent numerous exchanges of central catheter due to occlusion of the catheter. Thereafter, to prevent the development of bacterial resistance to vancomycin, IV daptomycin 400 mg infusions every 24 hours (approximately 6 mg/kg) was started. However, an immediate increase of eosinophils to 6% was noted immediately after the initiation of daptomycin, but the development of eosinophilia was not associated with exacerbation of asthma. This discordance between the lack of asthma attacks and eosinophilia persisted for 12 weeks of therapy with daptomycin. After that, the vancomycin therapy was re-initiated (2 weeks after the last dose of daptomycin). Subsequently, the asthma exacerbations returned with increased severity and frequency. He did not receive steroid during treatment with daptomycin or vancomycin. Upon evaluation, an adverse drug reaction probability algorithm showed a probable score of 5, because of the timing and sequence of the drug administration and the return of more frequent asthma exacerbations after the re-initiation of vancomycin. Reinert JP, et al. Implications of Glycopeptide and Lipopeptide Antibiotics on Asthma Exacerbations in a Patient With Hyper-IgE Syndrome and Chronic Severe Asthma: A 803500798 Case Report. Journal of Pharmacy Technology 00: 1-5, No. 0, 14 Aug 2020. Available from: URL: http://doi.org/10.1177/8755122520949589

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Reactions 12 Sep 2020 No. 1821