DISCUSSION: Daptomycin-induced EP is a potentially fatal complication of daptomycin therapy, with 63 reported cases between 2004-2010. The hypothesized mechanism of daptomycin toxicity is that it binds readily to surfactant, and its accumulation invokes an immunologic response leading to lung injury. Previous case reports of daptomycin-induced EP that contained clinical characteristics of the presentation are summarized in Table 1. The common theme is the development of diffuse pulmonary infiltrates 2-4 weeks after initiation of daptomycin, leading to hypoxic respiratory failure. The need for prolonged mechanical ventilation and slow recovery despite the discontinuation of daptomycin, treatment with corticosteroids, and no intervening complications to prolong respiratory failure, makes our case different. It is possible that daptomycin, a renally excreted drug, persists in the lungs of patients with renal dysfunction and as such may lead to a prolonged course of EP. There are two other case reports in literature of daptomycin-induced EP in patients with ESRD that relapsed after discontinuation of steroids, with rapid resolution after re-initiation of long term steroids.