Challenges in managing a multifactorial eosinophilic pneumonia: daptomycin vs strongyloidiasis case report

BACKGROUND: Eosinophilia is defined as a blood eosinophil count > 500/mcL with etiology usually an allergic reaction or parasitic infection which can lead to serious organ damage. CASE PRESENTATION: A patient being treated for hardware infection develops eosinophilia while on daptomycin in the setting of a positive strongyloides antibody. The patient was on chronic steroids prior to admission for epitheliopathy which complicated care. The daptomycin was discontinued, ivermectin initiated to treat strongyloidiasis, and high dose steroids initiated simultaneously. Eosinophilia resolved and patient discharged home after two months in the hospital. CONCLUSION: Multifactorial eosinophilia poses question of steroid harm in the setting of parasitic infection. Patient was treated for both strongyloides and daptomycin induced eosinophilia with improvement and discharge from the hospital.