Eosinophilic pneumonia associated with daptomycin: a case report and a review of the literature

Abstract

Introduction: Although several studies did not demonstrate that daptomycin may cause significantly higher rates of pulmonary adverse effects when compared with vancomycin or penicillinase-resistant penicillins, there have been a few case reports of severe pulmonary complications associated with daptomycin administration.

Case presentation: A rare case of eosinophilic pneumonia occurring 10 days after daptomycin administration in a 78-year-old Caucasian man with possible infectious endocarditis is described. He developed new onset fever, up to 38.5°C, with bilateral pulmonary crackles on physical examination and with no signs of severe respiratory failure. A chest computed tomography-scan showed bilateral nodular consolidations with air bronchograms and pleural effusions. Immediate discontinuation of daptomycin was followed by vigorous improvement of clinical signs and symptoms with progressive resolution of pulmonary consolidations a month later.

Conclusion: Physicians should be aware of this rare but serious complication during daptomycin treatment, and prompt discontinuation of the offending agent, with or without additional supportive treatment, must occur immediately.

Figure 1

Chest Radiograms. a. Chest X-ray demonstrating bilateral perihilar alveolar edema with a "butterfly" appearance and bilateral pleural effusions. b. Chest X-ray after pharmaceutical treatment for the congestive heart failure symptoms. Most of the initially appeared radiographic findings have been almost completely resolved.

Figure 2

Chest HRCT-scans. a. Chest HRCT-scan demonstrating bilateral irregularly shaped nodular consolidations with air bronchograms and bilateral pleural effusions. b. Chest HRCT-scan, one month after daptomycin discontinuation, demonstrating complete resolve of nodular consolidations and bilateral effusions.