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Daptomycin-induced Acute Eosinophilic Pneumonia
Sundeep Kumar1, Israel Acosta-Sanchez1, Natarajan Rajagopalan2
1Internal Medicine, University of Central Florida College of Medicine, Orlando, USA.
Abstract:
Acute eosinophilic pneumonia (AEP) is a rare entity, often resulting in respiratory failure and the attended mortality. Daptomycin-induced AEP results from immune-mediated pulmonary epithelial cell injury. A 65-year-old male on treatment with intravenous daptomycin for three weeks came to the hospital for worsening dyspnea and acute hypoxemic respiratory failure. Computerized tomography (CT) of the chest was done, revealing bilateral pulmonary infiltrates. He underwent bronchoscopy that showed predominant pulmonary eosinophilia. The bacterial, fungal, viral, and mycobacterial cultures were all negative. Daptomycin was discontinued, and the patient was started on steroid therapy. He received a two-week course of steroids with a rapid taper, attaining complete recovery with a near-complete resolution of pulmonary infiltrates. A shorter course of steroid therapy should be sufficient to treat a case, as indicated in our case. Commonly used diagnostic criteria for AEP using more than 25% of pulmonary eosinophilia should be tailored to patient-related factors.
Insights
Acute eosinophilic pneumonia (AEP) caused by daptomycin can lead to respiratory failure. Early discontinuation of daptomycin and steroid therapy resulted in rapid recovery, suggesting tailored diagnostic criteria for AEP.
Area of Science:
- Pulmonology
- Pharmacology
- Immunology
Background:
- Acute eosinophilic pneumonia (AEP) is a rare but serious condition.
- Daptomycin is an antibiotic that can induce AEP through immune-mediated lung injury.
Observation:
- A 65-year-old male presented with dyspnea and hypoxemic respiratory failure after three weeks of daptomycin treatment.
- Chest CT revealed bilateral pulmonary infiltrates, and bronchoscopy showed significant pulmonary eosinophilia.
Findings:
- Bacterial, fungal, viral, and mycobacterial cultures were negative, ruling out infection.
- Discontinuation of daptomycin and initiation of steroid therapy led to rapid clinical and radiological improvement.
Implications:
- This case highlights daptomycin as a potential cause of AEP.
- A shorter course of steroids may be sufficient for treatment.
- Diagnostic criteria for AEP may need patient-specific adjustments.
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