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[Case of severe eosinophilic pneumonia, induced by several antibiotics, requiring mechanical ventilation]
Takehiro Nakamura1, Yukiko Kawanami, Mika Yoshimoto
1Division of Respiratory Disease, University of Occupational and Environmental Health.
Abstract:
We report a case of severe eosinophilic pneumonia induced by several antibiotics, requiring mechanical ventilation. A 44-year-old man had been admitted previously to a different hospital because of a high fever and dry cough continuing for a week. Although bacterial pneumonia was diagnosed and he had been treated with several antibiotics, his respiratory state worsened gradually and he was refered to our hospital with severe hypoxia. He needed mechanical ventilation on the fifth hospital day. TBLB identified eosinophilic pneumonia. Although we discontinued all antibiotics and started steroid therapy, he became feverish and his leukocyte count, which was neutrophil dominant, elevated again. We suspected bacterial pneumonia and administered antibiotics that he had never received before. However we had to discontinue these antibiotics soon because of a further inflammatory response. His condition then improved gradually and he was weaned from mechanical ventilation. It is rare for drug-induced eosinophilic pneumonia to become so severe that mechanical ventilation is necessary. We thought that an allergic reaction may have been induced by the series of several antibiotics, inducing severe pneumonia.
Insights
Severe antibiotic-induced eosinophilic pneumonia required mechanical ventilation in a patient. Discontinuation of antibiotics and steroid therapy led to gradual improvement, highlighting rare but critical drug reactions.
Area of Science:
- Pulmonology
- Pharmacology
- Critical Care Medicine
Background:
- Antibiotic-induced hypersensitivity reactions can manifest in various ways.
- Eosinophilic pneumonia is a rare but serious adverse effect of certain medications.
Observation:
- A 44-year-old male presented with severe hypoxia and respiratory distress, initially diagnosed with bacterial pneumonia.
- Despite broad-spectrum antibiotic treatment, his condition worsened, necessitating mechanical ventilation.
- Bronchoscopic lung biopsy confirmed eosinophilic pneumonia, suggesting a drug-induced etiology.
Findings:
- Discontinuation of all antibiotics and initiation of steroid therapy did not immediately resolve symptoms.
- Re-challenge with novel antibiotics led to a further inflammatory response, prompting their discontinuation.
- Subsequent gradual improvement and successful weaning from mechanical ventilation occurred after all antibiotic agents were stopped.
Implications:
- This case underscores the potential for severe, life-threatening eosinophilic pneumonia due to multiple antibiotic exposures.
- It highlights the diagnostic challenge and management complexity of drug-induced lung injury.
- Physicians should consider drug-induced eosinophilic pneumonia in refractory respiratory failure, even after initial antibiotic treatment.
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