Acute Eosinophilic Pneumonia: A Rare Complication of Daptomycin Therapy

Daptomycin is a cyclic lipopeptide antibiotic with great efficacy targeting gram-positive cocci, including methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococcus. Acute eosinophilic pneumonia is a rare complication of daptomycin therapy, with a poorly understood etiology thought to involve the accumulation of the drug in pulmonary surfactant inducing inflammation. We present a 56-year-old male with a history of spinal epidural abscess being treated with intravenous daptomycin, who presented to the emergency department with fever, developed worsening shortness of breath, and was subsequently discovered to have eosinophilia of pulmonary secretions via bronchoalveolar lavage. Daptomycin was discontinued, and he underwent treatment with corticosteroids, resulting in full resolution of symptoms. Diagnosis of acute eosinophilic pneumonia requires a high degree of clinical suspicion. Identification may be further complicated by the fact that symptoms can present anywhere from days to weeks after starting the therapy. This complication is very responsive to treatment with corticosteroids and cessation of daptomycin, but recognition is essential. With an increasing use of daptomycin subsequent to continued emergence of antibiotic resistance, it is essential that physicians are aware of this rare complication of daptomycin therapy.