Daptomycin-Induced Eosinophilic Pneumonitis

At 3 months following double valve replacement for aortic valve and mitral valve stenosis, a 65-year-old male patient presented with early prosthetic valve endocarditis. Blood culture identified Staphylococcus epidermidis. Following repeat replacement of the aortic and mitral valve prostheses, the patient was transferred from the intensive care unit on the 7^th postoperative day. On the 13^th postoperative day, the patient developed acute respiratory failure. Computed tomography showed patchy confluent bipulmonary infiltrates with sparing of the lung periphery (Figure). Eosinophilic granulocytes were found in the bronchoalveolar lavage. After excluding other drug-related (e.g., amiodarone-associated) toxic causes, daptomycin-induced eosinophilic pneumonitis was diagnosed. The patient had been treated with daptomycin for 28 days at 850 mg/day and for a further 6 days at 700 mg/day. It is assumed that in a small number of patients, daptomycin induces secondary inflammatory processes in the lungs, resulting in impaired lung function. Following treatment with prednisolone and a switch of antibiotics, the patient was weaned off non-invasive ventilation over 4 weeks. Despite a clinical improvement, peribronchial infiltrates were seen on X-ray 41 days later. Increased use of the reserve antibiotic daptomycin could lead to a higher incidence of this complication in the future.

Figure

Contrast-enhanced computed tomography of the chest

Dr. med. Polyxeni Vlachea, PD Dr. med. Florian Herrmann, Herzchirurgische Klinik und Poliklinik, LMU Klinikum, München,

Danksagung: Wir danken Frau Dr. med. Lara Scharpf (Radiologie, Standort Augustinum Klinik) für die Anfertigung und Befundung der Computertomografien und dem gesamten Team der Intensivstation HCI der Herzklinik am Standort Augustinum unter der Leitung von Frau Dr. med. Marion Weis für die langwierige und durchweg motivierte Behandlung des Patienten.

Conflict of interest statement: The authors declare that no conflict of interest exists.

Translated from the original German by Christine Rye.

Cite this as: Vlachea P, Herrmann F: Daptomycin-induced eosinophilic pneumonitis. Dtsch Arztebl Int 2024; 121: 626. DOI: 10.3238/arztebl.m2024.0101