Daptomycin-associated eosinophilic pneumonia with rechallenge: a case report


Area of Science:

• Pulmonary Medicine
• Infectious Diseases
• Pharmacology

Background:

• Daptomycin is an antibiotic used to treat serious Gram-positive bacterial infections, including those caused by MRSA.
• Acute eosinophilic pneumonia (AEP) is a rare but serious adverse reaction that can be associated with certain medications.
• Diagnosis of drug-induced AEP often involves excluding other causes and observing clinical improvement upon drug withdrawal.

Observation:

• A 70-year-old woman developed respiratory symptoms, including cough and shortness of breath, approximately 9 days after initiating daptomycin for MRSA osteomyelitis.
• Initial improvement with antibiotics was followed by respiratory decline, with peripheral eosinophils elevated at 11.6%.
• Bronchoalveolar lavage (BAL) showed 5% eosinophils, and symptoms rapidly improved after daptomycin discontinuation.

Findings:

• A positive rechallenge with daptomycin within 24 hours led to the return of respiratory symptoms, confirming daptomycin as the causative agent of AEP.
• The case suggests a broadened definition of pulmonary eosinophilia associated with daptomycin, potentially including cases with lower BAL eosinophil percentages than previously defined.
• Peripheral eosinophilia may serve as an indicator of AEP when BAL is not feasible.

Implications:

• Clinicians should consider daptomycin as a potential cause of pneumonia presenting with abnormal eosinophil counts, especially after excluding other etiologies.
• This case highlights the importance of considering drug-induced AEP in patients on daptomycin therapy with unexplained respiratory symptoms.
• Prompt recognition and discontinuation of daptomycin can lead to rapid recovery without the need for corticosteroids.