Abstract Introduction As antibiotic usage continues to climb, multidrug resistant organisms, such as methicillin resistant Staphylococcus aureus (MRSA), make treatments more complex. Antibiotics that can treat MRSA include daptomycin, a strong antibacterial agent with a half-life of 8 hours and the potential for rare but severe adverse effects. Daptomycin-induced eosinophilic pneumonia (DIEP) is one such side effect, theorized to be from the drug binding to lung surfactant. It can cause acute onset of symptoms including fever, dyspnea, and bilateral pulmonary infiltrates consisting of greater than 25% eosinophils. The condition can be confused for other causes of lung injury and can be life threatening if not managed quickly. We describe a male with DIEP development after treatment for a prosthetic joint infection. Case A 70-year-old male presented to the ED following a home health chest x-ray suggestive of pneumonia. He had a history of a methicillin-resistant Staphylococcus prosthetic joint infection and was being treated at home with IV daptomycin. Following a mishap in his daptomycin dosing schedule in which he took two doses close together, he developed lightheadedness, fatigue, and progressively worsening dyspnea. Blood tests showed peripheral eosinophilia, and bronchoalveolar lavage showed 25% eosinophils. His daptomycin was discontinued within 24 hours of his symptom development, and resolution occurred within four days. Discussion The clinical features, diagnosis, and treatment of DIEP were consistent with the current guidelines for managing acute eosinophilic pneumonia. Previous reports of DIEP have not shown any connection between increased dosage and the development of symptoms. This case raises the possibility of a concentration-dependent or interval-sensitive mechanism of DIEP, a previously undescribed phenomenon. Additional studies are needed to determine whether increases in daptomycin dosage can precipitate the development of DIEP. Conclusion Although rare, DIEP can mimic other lung conditions such as pneumonia and acute respiratory distress syndrome (ARDS). Because of this mimicry, clinicians should be aware of DIEP and be prepared to take immediate action to prevent improper treatment or serious complications. The potential of DIEP having a dose or concentration-related element, as discussed in this case report, warrants further research. This abstract is funded by: None
Sentmanat et al. (Fri,) studied this question.
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