SHM Converge Scientific Abstract ePoster Gallery-Hypoxemia and Eosinophilic Pneumonia: A Rare Adverse Effect of Daptomycin

Pdf Summary

This case report describes a rare adverse effect of daptomycin: eosinophilic pneumonia causing hypoxemia. A 63-year-old man with well-controlled HIV, diabetes, and acute kidney injury developed acute shortness of breath, altered mental status, and oxygen requirement after a recent 4-week course of daptomycin and ciprofloxacin for diabetic foot infection. Imaging showed bilateral upper-lung predominant ground-glass opacities with subpleural sparing, and extensive infectious testing was negative. His mental status and renal function improved with supportive care and antibiotic changes, but his oxygen need persisted until prednisone was started, after which he improved to room air.<br /><br />The report highlights FDA diagnostic criteria for daptomycin-induced eosinophilic pneumonia (DIEP), which include daptomycin exposure, fever, dyspnea with increased oxygen needs, new infiltrates, bronchoalveolar lavage eosinophilia, and improvement after stopping daptomycin. The patient met four of these criteria, consistent with many published cases. Risk factors discussed included older age, male sex, diabetes, obesity, and renal dysfunction. Because daptomycin is primarily renally excreted, worsening kidney injury may increase toxicity risk.<br /><br />The authors emphasize that current FDA criteria may be too restrictive, and that clinicians should suspect DIEP in patients with new hypoxemia, pulmonary infiltrates, recent daptomycin exposure, and negative infectious work-up. Characteristic CT findings and response to drug withdrawal plus corticosteroids may be especially helpful for diagnosis.

Asset Subtitle

Christina Tsai

Meta Tag

Author List Brett Chen, Christina Tsai, Eric A. Meyerowitz, Jing-Yu Pan

Category Clinical Vignettes

Concept Daptomycin-induced acute eosinophilic pneumonia

Concept Hypoxemia

Concept Pulmonary Infiltrate

Concept Daptomycin

Concept Dyspnea

Distinguished Non-Finalist

Presenter Organization Department of Medicine, Montefiore Medical Center

Presenting Author Christina Tsai

Track Adult

Keywords

daptomycin

eosinophilic pneumonia

hypoxemia

ground-glass opacities

acute kidney injury

diabetes

HIV

corticosteroids

drug-induced lung injury

FDA diagnostic criteria

Daptomycin-induced acute eosinophilic pneumonia

Hypoxemia

Pulmonary Infiltrate

Daptomycin

Dyspnea