Daptomycin
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Daptomycin Acute eosinophilic pneumonia: 2 case reports
In a case series, two men aged 70 years and 50 years were described, who developed acute eosinophilic pneumonia during treatment with daptomycin for Staphylococcus aureus infections [dosages, routes and durations of treatments to reactions onsets not stated]. Case 1: The 70-year-old man was admitted with high-grade fever, dry cough and dyspnoea. Anamnesis revealed that he recently underwent a right total hip arthroplasty. However, 3 weeks prior to the current admission, the arthoplasty had been complicated with Staphylococcus aureus bacteraemia. Therefore, he had started receiving daptomycin. On examination he was tachypnoeic and tachycardic, and had coarse crackles on chest auscultation. His WBC count was at 21 000 /µL (with 10% peripheral eosinophils). A CT scan of chest demonstrated diffuse bilateral patchy nodular infiltrate in the upper and lower lobes, concerning for pneumonia or septic emboli. His IgE level was increased, and a bronchoalveolar lavage showed 41% eosinophils. A transbronchial biopsy of left lower lobe revealed organising pneumonitis with increased eosinophils. A diagnosis of acute eosinophilic pneumonia secondary to daptomycin was made. Daptomycin was withdrawn. The man was treated with prednisone. Within 48 hours, the presenting symptoms resolved. Case 2: The 50-year-old man was admitted with cough and dyspnoea which he had been experiencing since last three days. Anamnesis revealed that he recently underwent open reduction and internal fixation of clavicle fracture. However, he had developed methicillin-resistant Staphylococcus aureus surgical site infection. Therefore, he had started receiving daptomycin. On admission, he was tachycardic and febrile, and had leucocytosis. A chest CT scan demonstrated peripherally orientated solid and ground-glass nodules in both lungs and several wedge-like subpleural nodules, initially concerning for septic emboli with infarction or atypical infection. Daptomycin was withdrawn. The man was treated with unspecified broad spectrum antibiotics. Subsequent infectious work-up was found to be negative. Within 36 hours of stopping antimicrobial therapy, his presenting symptoms resolved. On day 4, a repeat chest-CT showed complete resolution of some of solid and ground glass nodules and interval decrease in size of others. A diagnosis of acute eosinophilic pneumonia secondary to daptomycin was made. Ghani M, et al. Two cases of daptomycin-induced acute eosinophilic pneumonia. American Journal of Respiratory and Critical Care Medicine 199: No. 9, May 2019. Available from: URL: https://www.atsjournals.org/doi/abs/10.1164/ajrccm-conference.2019.199.1_MeetingAbstracts.A1506 [abstract]
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Reactions 18 Jan 2020 No. 1787
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