Critical Care: Student/Resident Case Report Poster - Critical Care V |

Acute Eosinophilic Pneumonia Complicated by Daptomycin FREE TO VIEW

Kurt Olson, MD; Arooj Kayani, MD; Rajeev Saggar, MD
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University of Arizona-Phoenix, Gilbert, AZ

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):462A. doi:10.1016/j.chest.2016.08.475
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SESSION TITLE: Student/Resident Case Report Poster - Critical Care V

SESSION TYPE: Student/Resident Case Report Poster

PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM

INTRODUCTION: Acute Eosinophilic Pneumonia (AEP) is a rare and potentially fatal respiratory syndrome. The most common cause is idiopathic, but it also is associated with drugs and toxins, infections and radiation therapy.1 We describe a probable case of AEP complicated by daptomycin therapy.

CASE PRESENTATION: A 55-year-old male, former smoker, presented to the hospital with left olecranon bursitis complicated by MRSA. He underwent debridement and was placed on i.v. daptomycin and discharged home. On day 7, the patient developed progressive shortness of breath, low grade fevers, and a dry cough. 2 days later, he presented with T=97.6, BP 150/80, HR 112, RR 22, and oxygen saturation 82% on room air consistent with acute hypoxic respiratory failure. He was placed on high flow oxygen and CTA chest demonstrated bilateral, diffuse, patchy ground glass infiltrates with mild bibasilar bronchiectasis and upper lobe paraseptal emphysema. White blood cell count was 17.5 with 4.4% eosinophils (0-5.0%). Daptomycin induced pulmonary toxicity was immediately suspected and was subsequently discontinued. He was transitioned to i.v. vancomycin and cefepime and initiated on high dose i.v. corticosteroids. Bronchoscopy was performed the next day without eosinophilia but with cytology disclosing foamy histiocytes and mixed inflammation. Subsequent cultures disclosed no evidence of microorganisms. He made significant improvement with resolution of peripheral eosinophilia. He was discharged on an 8 week steroid taper with follow up CT chest revealing almost complete resolution of airspace disease.

DISCUSSION: AEP is a rare and potentially serious complication of daptomycin theray. Its mechanism of pulmonary toxicity is possibly associated with irreversibly binding to surfactant.2 A clinical diagnosis of AEP can be made in patients who meet the following criteria: A febrile illness of less than one week, hypoxemic respiratory failure, diffuse pulmonary opacities on chest radiograph, BAL differential cell count showing eosinophilia, and absence of known causes of eosinophilic pneumonia asthma or atopic disease.1 Treatment involves early discontinuation of offending agent and prompt initiation of corticosteroids.

CONCLUSIONS: Early recognition was critical and led to the quick recovery of this form of daptomyocin induced hypoxic respiratory failure. In our case, although there was no evidence of eosinophilia, it did meet the Naranjo definitive criteria for adverse drug reaction.3

Reference #1: Cordier J, Cottin V. Eosinophilic pneumonias. In: Interstitial Lung Disease, 5th, Schwarz MI, King TE Jr. (Eds), People's Medical Publishing House-USA, Shelton, CT 2011. P.833.

Reference #2: Mehta P, Wong W, Ramalingam S, Aucoin P, Chandak T Daptomycin-induced acute eosinophilic pneumonia an emerging clinical entity. Chest. 2012;142: 1042A-1042A.

Reference #3: Naranjo CA, Busto U, Sellers EM, et al. (1981). A method for estimating the probability of adverse drug reactions. Clinical Pharmacology and Therapeutics. 30 (2): 239-45.

DISCLOSURE: The following authors have nothing to disclose: Kurt Olson, Arooj Kayani, Rajeev Saggar

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