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Pneumonia (first report with duloxetine): case report A 30-year-old woman developed acute eosinophilic pneumonia (AEP) during treatment with duloxetine for depression; the AEP recurred during treatment with fluoxetine [therapeutic indication not stated]. The woman, who had recently started receiving duloxetine [dosage and duration of therapy not stated], was diagnosed with pneumonia and prescribed antibacterials. On the following day, she was admitted with fever, chills, dyspnoea, cough and nausea, which had started 5 days previously; her concomitant medication included azithromycin. On admission, she showed signs of mild distress; she had a BP of 95/55mm Hg, a temperature of 39.5°C and a HR of 144 beats/min. Her respiratory rate was 20 and her oxygen saturation was 90% on room air. A lung examination showed diffuse crackles. Her WBC count was 20.4 × 103/mL, with 86% segmented neutrophils. Analysis of arterial blood gas revealed partial pressures of carbon dioxide and oxygen of 30mm Hg and 49mm Hg, respectively, and an oxygen saturation of 84%. A chest x-ray revealed worsening bilateral consolidations. The woman received oxygen and a combination of ceftriaxone and azithromycin. She developed respiratory failure and shock on the following day, was intubated and received vasopressors. A bronchoalveolar lavage revealed no pathogens, but 80% eosinophils. Subsequently, duloxetine was stopped and methylprednisolone was started. After 2 days, treatment with vasopressors and antibacterials was stopped and she was extubated 1 day later. She developed peripheral eosinophilia. She was discharged on prednisone, fluoxetine [dosage not stated] and gabapentin on hospital day 8. Her eosinophilia resolved then recurred [time to reaction onset not stated] until fluoxetine treatment was discontinued. A chest x-ray 3 weeks after discharge was normal. Author comment: This case fulfills the criteria for AEP, "with duloxetine and secondarily fluoxetine the inciting agents". Salud II AV, et al. Too much of a good thing: acute eosinophilic pneumonia with a 801043038 new anti-depressant. Chest 128 (Suppl.): 427, No. 4, Oct 2005 - USA

» Editorial comment: A search of AdisBase, Medline and the WHO Adverse Drug Reactions database did not reveal any previous case reports of pneumonia associated with duloxetine.

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Reactions 5 Aug 2006 No. 1113