Eosinophilic Pneumonia Induced by Daptomycin

Abstract

Daptomycin-induced eosinophilic pneumonia (DIEP) is a rare but serious complication associated with the use of this broad-spectrum antibiotic. We present the case of a teenager with a history of nasopharyngeal cancer who developed DIEP while receiving daptomycin to treat an infection associated with an implanted chamber catheter. Symptoms included recurrent dyspnea and peripheral eosinophilia, with radiological findings consistent with DIEP. The pathophysiology involves an immune response triggered by daptomycin, resulting in eosinophilic pulmonary inflammation. Diagnosis requires a thorough evaluation of medical history, clinical laboratory tests, and radiological findings. The main treatment involves discontinuation of daptomycin and, in severe cases, the use of steroids. It is essential to consider DIEP in patients with respiratory failure and bilateral pulmonary opacities who have used daptomycin and to suspect it in those with blood eosinophilia or in bronchoalveolar lavage.

Keywords: daptomycin; drug-related side effects and adverse reactions; eosinofilia pulmonar; pulmonary eosinophilia; radiology.

Figure 1. Chest X-ray in PA and lateral projection

Multiple bilateral nodular opacities of variable size, some of them with small radiolucent foci within them, suggest cavitations (arrows). PA: posteroanterior

Figure 2. Chest CT

Chest CT in the simple lung parenchyma window in the axial plane (A) and coronal plane (B) and contrast-enhanced chest CT in the soft tissue window in the coronal plane (C) and axial plane (D). Bilateral peripheral solid nodules of variable size, some of them cavitated (arrows in A and B), correlating with the opacities seen on the chest X-ray. Partial thrombosis of the superior vena cava (arrows in C and D). CT: computed tomography

Figure 3. Chest CT with intravenous contrast in the lung parenchyma window

Coronal plane (A) and axial plane (b). Bilateral peripheral ground-glass opacities (arrows) involving all lung lobes associated with the thickening of interlobular septa; some of the opacities are surrounded by a denser consolidation border, forming the atoll sign or reverse halo (Arrow in B). CT: computed tomography

Figure 4. High-resolution chest CT two months after discontinuation of daptomycin in the axial plane and lung parenchyma window

Resolution of parenchymal opacities present in previous studies (A and B). CT: computed tomography