Two patients with daptomycin induced eosinophilic pneumonia with different presentations and treatment

Abstract

We present two cases of daptomycin-induced eosinophilic pneumonia with characteristic chest x ray, CT scan and bronchoalveolar lavage (BAL) findings. It is not a commonly seen complication of Daptomycin but when it happens, it could cause a diagnostic and treatment dilemma. Patients could present acutely with hypoxic respiratory failure or a less dramatic chronic presentation is also possible. Our two patients presented with acute hypoxic respiratory failure and presentation resembles that of an infectious etiology. Diagnosis is confirmed by bronchoscopy with BAL in one of them and the other was treated empirically as the clinical and radiologic presentation was typical. Treatment includes removal of the offending agent, daptomycin. Corticosteroids are used if symptoms are severe and can result in rapid clinical improvement. There is no agreed upon dose and duration of steroids and we suggest a long taper of steroids for patients who present with severe symptoms and a short course steroid for patients with milder symptoms.

Unexpected Outcome of Daptomycin-induced Eosinophilic Pneumonia: Rarity Within a Rarity

“…Steroids are recommended to patients with acute lung injuries caused by amiodarone, cocaine, and bleomycin. Most of the case reports on daptomycin-induced AEP responded almost immediately within 48-72 hours with dramatic improvement in patient’s symptoms [13]. In our patient, while the diagnosis was supported by clinical criteria, radiographic data, peripheral eosinophilia, history of drug use, and very high eosinophil count of BAL fluid, we struggled with his management despite starting the patient on steroids and optimizing the fluid status.…”