Bedaquiline-induced eosinophilic pneumonitis in treatment-refractory mycobacterium avium complex (MAC) lung disease

We report the first known case of eosinophilic pneumonitis induced by bedaquiline, a drug increasingly used off-label for non-tuberculous mycobacterial infections. While bedaquiline is generally well tolerated, its potential to cause pulmonary hypersensitivity reactions has not been previously reported. This case highlights the need for heightened clinical awareness of novel adverse effects as bedaquiline use expands beyond its original indication for multidrug-resistant tuberculosis. Clinicians should consider eosinophilic pneumonitis in patients developing new respiratory symptoms and peripheral eosinophilia while on bedaquiline, ensuring timely diagnosis and management to prevent serious complications.