Daptomycin-Induced Eosinophilic Pneumonia: A Case Report and Systematic Review

Area of Science:

• Pulmonology
• Infectious Diseases
• Pharmacology

Background:

• Acute eosinophilic pneumonia (AEP) is a rare respiratory condition characterized by eosinophil infiltration of lung tissue.
• Daptomycin, an antibiotic for gram-positive bacteria, is a known cause of drug-induced AEP.
• This study highlights a case of daptomycin-induced AEP in a patient with endocarditis and reviews similar cases.

Approach:

• A systematic literature review was conducted following PRISMA guidelines.
• Searches used terms 'daptomycin AND eosinoph* AND pneum*' across Medline, CINAHL, and Embase.
• Data from 120 patients across 93 records (2007-2023) were analyzed, with observational studies appraised by the Newcastle-Ottawa Scale.

Key Points:

• The review identified 120 patients (73.3% male, mean age 68.28 years) who developed AEP after daptomycin treatment, often for osteoarticular infections (62.5%).
• Daptomycin was frequently used off-label (74%), with AEP symptoms appearing after a mean of 21.75 days.
• Common symptoms included fever, dyspnea, cough, and respiratory failure; treatment involved daptomycin withdrawal, respiratory support, and corticosteroids, leading to recovery in most patients (116/120).

Conclusions:

• Daptomycin-induced AEP is a rare but potentially fatal complication, often associated with prolonged daptomycin therapy.
• Awareness is crucial as AEP can be misdiagnosed as infectious pneumonia, delaying treatment.
• Increased risk with longer drug exposure necessitates caution when considering extended daptomycin regimens.