Resident ECU Health Medical Center Winterville, North Carolina, United States
Case Diagnosis: Daptomycin-induced eosinophilic pneumonia leading to acute respiratory failure
Case Description: 37 year old male with a history of charcot joint and chronic left tibial osteomyelitis underwent amputation and removal of hardware, incision and drainage, and wound vac placement was admitted to inpatient rehabilitation. After initial progress and the need for long term antibiotics, the patient began to develop respiratory symptoms, including worsening oxygen requirements. Workup showed nonspecific changes in the left lower lobe for pneumonia, negative viral panel, and a negative sputum culture. Chest X-ray showed multifocal pneumonia, worse on the left than right. Eventually, the patient's oxygen status worsened further and CT chest showed significant airspace disease unresponsive to further antibiotics. Therefore, the patient was admitted to the acute hospital for further management by Pulmonology and Infectious disease.
Discussions: The patient was hypothesized to have Daptomycin-associated eosinophilic pneumonia, therefore he underwent a steroid taper without any significant complications. His oxygen was weaned significantly and his respiratory status improved over days. Given the complication to Daptomycin, the patient was eventually recommended to transition to Ceftriaxone for the remainder of his antibiotic duration, which was completed without any acute issues. The patient's eosinophilic pneumonia resolved with a treatment of steroids, Vancomycin, and Cefepime, with eventual transition to Dalbavancin.
Conclusions: Daptomycin-induced eosinophilic pneumonia can be a rare but serious complication of prolonged treatment. Query should be given to patient's who develop worsening respiratory status in the setting of this antibiotic, particularly for those patients who underwent a significant surgery such as an amputation, have a concurrent infection such as osteomyelitis, or have multiple comorbidities that put them at risk for clinical decompensation. This patient's respiratory status significantly improved, and he was able to complete the remainder of his inpatient rehabilitation course without any significant complications.
