A TALE OF A DRUG THAT KILLED A BUG BUT CAUSED PNEUMONIA: A CASE REPORT OF DAPTOMYCIN-INDUCED ACUTE EOSINOPHILIC PNEUMONIA
Chest
; 162(4):A1286, 2022.
Article
in English
| EMBASE | ID: covidwho-2060794
ABSTRACT
SESSION TITLE Critical Diffuse Lung Disease Cases 2 SESSION TYPE Case Report Posters PRESENTED ON 10/19/2022 1245 pm - 0145 pm INTRODUCTION:
Acute eosinophilic pneumonia (AEP) is dramatic in presentation mimicking infectious pneumonia or acute respiratory distress syndrome in previously healthy individuals. Medications are a commonly recognized cause of AEP. Daptomycin, has been strongly linked to AEP. Herein, we present a case of a patient with a septic joint treated with Daptomycin who went on to develop AEP. CASE PRESENTATION Patient is an 80 year old man with history of hypertension, hypothyroidism, atrial flutter, complete heart block status post pacemaker, who had a hx of a mucinous cyst on his left index finger, requiring hospitalization. Blood cultures were positive for MRSA s/p debridement of the joint. He was discharged on 4 weeks of intravenous daptomycin. Two weeks after being discharged he presented back to the hospital with fevers, fatigue and worsening shortness of breath. His temperature was 103.8 and O2 saturation of 90% on 2L NC. Laboratory findings included WBC count of 8.6 with no eosinophilia on differential, ESR 110, negative blood cultures, sputum cultures with commensal flora, negative urine legionella, PCR for SARS COV-2 was negative. Chest radiograph showed mild interstitial airspace disease in the left mid and lower thorax, along with small bilateral pleural effusions. CT chest showed scattered bilateral consolidations and ground glass opacities and trace bilateral effusions. Daptomycin was switched to Vancomycin. Patients oxygen requirements had increased to 6l NC. Patient underwent airway exam with bronchoscopy and broncheoalveolar lavage in superior segment of the lingula, which showed inflamed bronchial mucosa with copious secretions. Cell count of the BAL showed increased eosinophil count with negative gram stain and culture. Patient was started on methylprednisolone 60 mg four times per day and then tapered. Vancomycin was switched to oral linezolid. Patient's hypoxia improved and was discharged home on 3l NC. At four week follow up, he no longer required oxygen on ambulation and chest radiograph showed complete resolution of infiltrates.DISCUSSION:
Over 140 drugs have been recognized as a cause of drug induced eosinophilic pneumonia (DIEP). The diagnosis of DIEP requires febrile illness <5 days, diffuse bilateral infiltrates, hypoxemia and BAL showing 25% eosinophils or eosinophilic pneumonitis on lung biopsy. Additionally, a diagnosis of DIEP requires exposure to a candidate drug in the appropriate time frame, exclusion of infectious causes of eosinophilic pulmonary opacities. It also requires clinical improvement after cessation of medication. Daptomycin has been strongly linked to DIEP. In 2010 US FDA issued a warning about the risk of developing eosinophilic pneumonia during treatment with Daptomycin.CONCLUSIONS:
Daptomycin is strongly linked with DIEP. Clinicians should maintain a high index of suspicion for DIEP in patient treated with daptomycin who develop respiratory distress. Reference #1 Uppal, P., LaPlante, K.L., Gaitanis, M.M. et al. Daptomycin-induced eosinophilic pneumonia - a systematic review. Antimicrob Resist Infect Control 5, 55 (2016). https//doi.org/10.1186/s13756-016-0158-8 Reference #2 Cottin V. Eosinophilic Lung Diseases. Clin Chest Med. 2016 Sep;37(3)535-56. doi 10.1016/j.ccm.2016.04.015. Epub 2016 Jun 25. PMID 27514599. Reference #3 Rosenberg CE, Khoury P. Approach to Eosinophilia Presenting With Pulmonary Symptoms. Chest. 2021 Feb;159(2)507-516. doi 10.1016/j.chest.2020.09.247. Epub 2020 Sep 28. PMID 33002503;PMCID PMC8039005. DISCLOSURES No relevant relationships by Kamelia Albujoq No relevant relationships by Rajaninder Sharma
daptomycin; endogenous compound; linezolid; methylprednisolone; oxygen; protein c jun; vancomycin; adult respiratory distress syndrome; aged; airway; bacterium culture; blood culture; bodily secretions; bronchoscopy; bronchus mucosa; cardiac rhythm management device; cell count; cell culture; commensal; complete heart block; conference abstract; debridement; drug therapy; drug toxicity; dyspnea; eosinophil; eosinophil count; eosinophilia; fatigue; fever; flora; follow up; Food and Drug Administration; Gram staining; ground glass opacity; heart atrium flutter; hospitalization; human; human cell; human tissue; hypertension; hypothyroidism; hypoxemia; hypoxia; index finger; infectious pneumonia; intravenous drug administration; lavage; Legionella; leukocyte count; lung biopsy; lung disease; male; methicillin resistant Staphylococcus aureus; mobilization; mucocele; nonhuman; oxygen saturation; pleura effusion; respiratory distress; Severe acute respiratory syndrome coronavirus 2; sputum culture; surgery; systematic review; thorax radiography; tropical eosinophilia; very elderly
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Databases of international organizations
Database:
EMBASE
Type of study:
Case report
Language:
English
Journal:
Chest
Year:
2022
Document Type:
Article
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