Daptomycin
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Acute eosinophilic pneumonia: case report An 80-year-old man developed acute eosinophilic pneumonia during treatment with daptomycin for hand cellulitis. The man, who had a history of septic arthritis on the right knee, hypertension, type 2 diabetes, gout and allergy to ciprofloxacin, sulfa drugs and novocaine was admitted with a 4 week history of a rash on his right hand. He was initially treated with cefalexin, doxycycline and underwent incision and drainage procedure. After admission in the emergency room, he was diagnosed with right hand cellulitis and started receiving vancomycin. His blood cultures grew methicillin-resistant Staphylococcus aureus (MRSA) and his antibiotic treatment was switched to daptomycin 9 mg/kg once daily [route not stated] on day 3 of hospitalisation. On hospital day 4, he underwent further incision and drainage. Cultures obtained from incision and drainage showed growth of MRSA as well. On day 12 of hospitalisation, a peripherally inserted central catheter (PICC) line was placed and was discharged with continued daptomycin via PICC line for 6 weeks. But, after 9 days, he again presented to the emergency room with a sore throat, dyspnoea, runny nose, rigors, nonproductive cough and chills from the past few days. Apart from daptomycin, he was receiving various concomitant medications. Two days prior to the presentation, he stopped taking daptomycin. However, his right hand infection worsened with drainage. He received daptomycin therapy for a total of 19 days. Upon presentation, he had fever 101°F and elevated BP. He was admitted to medicine service with a provisional diagnosis of healthcare-associated pneumonia (HCAP) and an empirical treatment was started with meropenem, doxycycline and vancomycin. Laboratory tests upon admission showed WBC count 6.1 K/ UL, CRP 29.52 mg/L, eosinophil level 7%, procalcitonin level 0.77 ng/mL and ESR 75 mm/h. Chest X-ray showed patchy densities in the right lung and CT chest without contrast showed a peripheral pattern of air-space disease and ground-glass opacity more prominent on the right than on the left, involving all lobes. Some of the areas had a wedge shape, hyperinfiltration of the lungs and mild increase of AP diameter of the trachea. Based on these findings, eosinophilic pneumonia secondary to daptomycin therapy was suspected [time to reaction onset not stated]. According to Naranjo algorithm, a probable daptomycin-induced acute eosinophilic pneumonia was scored with 7 points. The man stopped receiving empiric treatment for HCAP on hospital day 6 and ceftaroline-fosamil was started for right hand MRSA infection. His blood cultures showed growth of gram negative rods, which were identified as Klebsiella, attributed to a PICC line infection. After removing the PICC line and receiving ceftaroline treatment, his blood cultures came back negative on the very next day. Within 36 hours of admission, he improved subsequently. A repeat chest X-ray showed a complete resolution of patchy densities in the right lung and without any evidence of acute
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