AEP associated with
daptomycin is reported in the literature, and the product labeling contains a warning and precaution statement. Criteria for diagnosing
daptomycin-induced AEP varies and generally includes bronchoalveolar lavage (BAL) eosinophils ≥ 25%. We report a case of a 70-year-old woman with
cough,
shortness of breath, and altered mental status who presented ~ 9 days after starting
therapy with
daptomycin to treat methicillin-resistant <italic>Staphylococcus aureus</italic> (MRSA)
osteomyelitis.
Daptomycin was utilized because of a presumed
vancomycin allergy.
Aspiration pneumonia was suspected and IV
ampicillin and
sulbactam was initiated. Clinical status improved initially but ~ 1 week later, her respiratory status declined. During work-up, peripheral eosinophils were abnormal at 11.6%, so
daptomycin therapy was discontinued. BAL revealed 5% eosinophils with negative infectious work-up. Respiratory status rapidly improved after discontinuation of
daptomycin.
Linezolid therapy was initiated. Due to an uncertain association with
daptomycin and concerns associated with long-term
linezolid therapy, the patient agreed to rechallenge with
daptomycin. Within 24 hours, respiratory symptoms returned and
daptomycin was permanently discontinued. The patient rapidly recovered without the need for systemic
corticosteroid treatment.
CONCLUSIONS: Our case supports a broadened definition of
pulmonary eosinophilia associated with
daptomycin administration. It is important for clinicians to consider
daptomycin as an etiology of
pneumonia with abnormal eosinophils when other causes have been excluded. Clinicians could also consider peripheral
eosinophilia as a possible indication of AEP when BAL is not available or cannot be obtained.
.