(1203) A Rare Case of Daptomycin-Induced Eosinophilic Pneumonia

Introduction: Daptomycin is a cyclic lipopeptide antibiotic known for its efficacy against methicillin-resistant Staphylococcus aureus (MRSA) and other gram-positive pathogens. Although it is mostly tolerated well, there have been rare reports of various adverse reactions associated with its use, including eosinophilic pneumonia.

Description: A 46-year-old male with a past medical history of end stage renal disease on peritoneal dialysis presented with shortness of breath and syncopal episode. On admission the patient was completing a course of IV Daptomycin and PO Linezolid started a week prior for MRSA bacteremia secondary to diabetic foot ulcers requiring a toe amputation. Chest x-ray on admission showed bilateral pulmonary infiltrates. Patient was later transferred to the ICU for acute on chronic respiratory failure with hypoxia. Diagnostic workup did not include a bronchoalveolar lavage, due to instability. CTA showed significant consolidative changes and patchy ground-glass opacities, a classic finding of eosinophilic pneumonia. Based on the clinical presentation and history of daptomycin use, a diagnosis of daptomycin-induced eosinophilic pneumonia was made and patient was immediately taken off daptomycin and started on doxycycline, piperacillin-tazobactam, and IV solumedrol. 48 hours of starting corticosteroid treatment, the patient was transferred out of the ICU as he showed marked improvement in symptoms and oxygen saturation. Repeat chest X-ray performed after corticosteroid treatment showed a marked decrease in previously observed bilateral infiltrates.

Discussion: Daptomycin is used for the management of severe gram-positive infections, especially those caused by MRSA. Providers should be aware of potential adverse effects, such as eosinophilic pneumonia, which can occur soon after initiation. Though the mechanism of daptomycin-induced eosinophilic pneumonia remains unclear, it is thought to involve a hypersensitivity reaction leading to eosinophil recruitment and activation in the lung tissue. The diagnosis of eosinophilic pneumonia can be difficult, as symptoms and imaging can mimic other respiratory conditions. Additionally bronchoalveolar lavage can be limited in unstable patient populations, and manifestations such as peripheral eosinophilia are rarely present and not diagnostic.