SHM Converge Scientific Abstract ePoster Gallery-Daptomycin Induced Acute Eosinophilic Pneumonia

Pdf Summary

This case report describes an 89-year-old man with coronary artery disease, pacemaker, and atrial fibrillation who developed hypoxic respiratory failure after four weeks of IV daptomycin for MSSA septic arthritis and bacteremia. He presented with two weeks of progressive dyspnea and a non-productive cough, without fever, smoking history, or relevant environmental exposures. Initial evaluation showed leukocytosis but no peripheral eosinophilia. Chest X-ray and CT demonstrated diffuse interstitial and patchy pulmonary infiltrates with small bilateral pleural effusions. He was initially treated as having community-acquired pneumonia.<br /><br />Because the diagnosis remained unclear, bronchoscopy with bronchoalveolar lavage (BAL) was performed. BAL revealed 24% eosinophils and 49% neutrophils, supporting acute eosinophilic pneumonia. Respiratory cultures grew only rare alpha-hemolytic Streptococcus at a level not usually considered clinically significant. The authors concluded that daptomycin-induced acute eosinophilic pneumonia was the most likely diagnosis.<br /><br />The report highlights diagnostic criteria for daptomycin-induced eosinophilic pneumonia, including concurrent daptomycin exposure, dyspnea with increased oxygen requirement, new pulmonary infiltrates, BAL eosinophilia (typically at least 25%), and improvement after stopping daptomycin. The case illustrates that peripheral eosinophilia may be absent early and that bronchoscopy can be essential for diagnosis.<br /><br />Overall, the article emphasizes the importance of recognizing daptomycin as a potential cause of noninfectious respiratory failure. Early identification and withdrawal of the drug are critical because the condition is reversible and can mimic bacterial pneumonia.

Asset Subtitle

Syed R. Shah

Meta Tag

Author List Benton Huang, Maninderjit Singh, Sobia Syed, Syed R. Shah

Category Clinical Vignettes

Concept Daptomycin

Concept Daptomycin-induced acute eosinophilic pneumonia

Concept Hypoxemic Respiratory Failure

Concept Bronchoalveolar Lavage

Concept Eosinophilia

Distinguished Non-Finalist

Presenter Organization University of Washington

Presenting Author Syed R. Shah

Track Adult

Keywords

daptomycin

acute eosinophilic pneumonia

hypoxic respiratory failure

bronchoalveolar lavage

BAL eosinophilia

pulmonary infiltrates

dyspnea

MSSA septic arthritis

bacteremia

drug-induced lung injury

Daptomycin

Daptomycin-induced acute eosinophilic pneumonia

Hypoxemic Respiratory Failure

Bronchoalveolar Lavage

Eosinophilia