SHM Converge Scientific Abstract ePoster Gallery-Daptomycin-Induced Acute Eosinophilic Pneumonia in the Setting of a Viral Respiratory Infection and Pyoderma Gangrenosum

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This case describes a 75-year-old woman with adrenal insufficiency, hypothyroidism, diabetes, remote cutaneous sarcoidosis, a painful abdominal ulcer, and a month-long dry cough with fatigue and subjective fevers. The ulcer developed at an insulin injection site and was treated empirically with doxycycline, then daptomycin for recurrent UTI coverage shortly before hospitalization.<br /><br />On admission, she had normal vital signs but a tender violaceous ulcer with undermined borders, suggestive of pyoderma gangrenosum (PG). Workup showed elevated inflammatory markers, a positive respiratory viral panel for parainfluenza virus 3, and chest CT with extensive ground-glass opacities and consolidations. Bronchoalveolar lavage revealed 24% eosinophils, and infectious studies were negative, supporting acute eosinophilic pneumonia (AEP), likely daptomycin-induced. Skin biopsy showed dense neutrophilic inflammation, consistent with PG; wound cultures were negative.<br /><br />The authors propose that her pre-existing viral respiratory infection and inflammatory skin disease may have created a pro-inflammatory state that increased susceptibility to daptomycin-related lung injury. They note that while AEP is usually associated with at least 25% eosinophils in BAL, prior steroid exposure may have slightly lowered the count.<br /><br />She was treated with prednisone 60 mg daily followed by a taper, but respiratory symptoms recurred at lower doses, requiring prolonged steroid therapy and later mepolizumab for suspected steroid-resistant disease. Her ulcer improved significantly with topical clobetasol and gentamicin.<br /><br />The report emphasizes early recognition of eosinophilic pneumonia in patients exposed to daptomycin, especially when other inflammatory triggers are present, and highlights a previously undescribed association between pyoderma gangrenosum and AEP.

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Allison Dumitriu Carcoana

Meta Tag

Author List Allison Dumitriu Carcoana, Harry Monestime, John Meisenheimer, Martin Giangreco, Nikesh Rohit Kapadia, Yashvi Shah

Category Clinical Vignettes

Concept Daptomycin-induced acute eosinophilic pneumonia

Concept Bronchoalveolar lavage eosinophilia

Concept Pyoderma Gangrenosum

Concept Drug Discontinuation

Concept Glucocorticoid Therapy

Distinguished Non-Finalist

Presenter Organization University of South Florida Health Morsani College of Medicine, Tampa, FL

Presenting Author Allison Dumitriu Carcoana

Track Adult

Keywords

daptomycin-induced acute eosinophilic pneumonia

pyoderma gangrenosum

bronchoalveolar lavage eosinophils

parainfluenza virus 3

ground-glass opacities

prednisone taper

mepolizumab

cutaneous sarcoidosis

insulin injection site ulcer

drug-induced lung injury

Daptomycin-induced acute eosinophilic pneumonia

Bronchoalveolar lavage eosinophilia

Pyoderma Gangrenosum

Drug Discontinuation

Glucocorticoid Therapy