Table 2.
Summary of 35 cases of presumed daptomycin-induced eosinophilic pneumonia
| Case | Age/Sex | Indication | Dose (mg/kg/day) | DAP Duration (wks) | Clinical Findings | Objective Findings | Treatment | Outcome |
|---|---|---|---|---|---|---|---|---|
| Kim [1] (2012) | 63/F | MSSA spinal osteomyelitis | 6 | 3 | • Fever • Cough, hypoxemia |
• BAL = 60–70% • Peripheral eosinophilia • Elevated CPK |
• DAP d/c • Corticosteroids |
Recovered |
| 64/M | Osteomyelitis with bacteremia | 5.7 | 4 | • Fever • Dyspnea, hypoxia |
• BAL = 44% • Peripheral eosinophilia • Pulmonary infiltrates |
• DAP d/c | Recovered | |
| 79/M | Endocarditis | 6 | 6 | • Fever, cough, night sweats • Dyspnea requiring MV |
• BAL = 9–13% • Peripheral eosinophilia • CT = ground glass opacities • Lung biopsy = eosinophilic pneumonitis |
• DAP d/c • Corticosteroids |
Improved | |
| 26/M | MRSA bacteremia | 7.35 | 1.4 | • Dyspnea requiring MV | • BAL not performed • Peripheral eosinophilia • Pulmonary infiltrates • Eosinophils in tracheal aspirate |
• DAP d/c | Improved | |
| 43/M | MRSA osteomyelitis | 6 | 1–2 | • Pleuritic pain • Hypoxia requiring O2 |
• BAL not performed • Peripheral eosinophilia • CT = bilateral infiltrates |
• DAP d/c • Given NSAIDs, meperidine |
• Improved • Residual infiltrates on CT s/p 4 wks |
|
| 66/M | MSSA bacteremia | 6 | 1 | • Dyspnea requiring O2
• Hematemesis |
• BAL with eosinophils (not quantified) • Peripheral eosinophilia |
• DAP d/c • Corticosteroids |
Recovered | |
| 71/M | MRSA diabetic foot infection | 4 | 7.7 | • Dyspnea requiring O2 | • Peripheral eosinophilia • Elevated CRP • Elevated ESR • CT = bilateral interstitial opacities |
• DAP d/c | Improved | |
| 77/F | Bacteremia (enterococcal) | 5 | 1 | • Dyspnea requiring O2 | • Peripheral eosinophilia • CXR = pneumonitis |
• DAP d/c • Corticosteroids |
Improved | |
| 67/M | MRSA endocarditis | 6 | 4.3 | • Dyspnea requiring MV | • BAL = 9% • Peripheral eosinophilia • CT = bilateral pulmonary infiltrates |
• DAP d/c • Corticosteroids |
Improved | |
| 73/M | Prosthetic joint infection | 5 | 3.7 | • Fever • Dyspnea requiring MV |
• Peripheral eosinophilia • CT = bilateral ground glass appearance |
• DAP d/c • Corticosteroids |
Recovered | |
| 81/F | MRSA paraspinal abscess | 6 | 1.6 | • Dyspnea requiring MV | • BAL = 2% (s/p corticosteroid)a
• CXR = bilateral mid-lung infiltrates |
• DAP d/c • Corticosteroids |
Improved | |
| Cobb [6] (2007) | 84/M | Infection of left knee prosthesis | 4 | 4 | • Decreased appetite • Weight loss • Fatigue • Weakness |
• Elevated ESR • CT with infiltrates • Lung biopsy = eosinophilic pneumonia |
• DAP d/c | • Improved within 2 weeks |
| Hayes [7] (2007) | 60/M | MSSA endocarditis | NR | 2 | • Fever, rigors, diaphoresis • Required MV |
• BAL 16% initially • BAL 26% after rechallenge • CRP elevated |
• DAP d/c – then re-challenged • DAP d/c plus corticosteroids |
• Rechallenge failed within 4 h • Improved within 24 h after DAP d/c |
| Kakish [8] (2008) | 65/M | MRSA vertebral osteomyelitis, epidural abscess | 6 | 2 | • Low-grade fever • Dyspnea requiring MV |
• BAL = 33% • Peripheral eosinophilia • Lung biopsy revealed eosinophils |
• DAP d/c • Corticosteroids |
• Improved within 72 h • Normal CT at 3 months |
| Shinde [9] (2009) | 54/M | Complicated inguinal hernia repair | NR | 2 | • Low grade fever, cough • Hypoxemia requiring MV |
• Peripheral eosinophilia • CT = bilateral airspace, peripheral predominance, small bilateral effusions • Lung biopsy = many eosinophils |
• DAP d/c • Corticosteroids |
• Improved within 24 h • Normal CT at 4 weeks |
| Lal [10] (2010) | 82/M | Prosthetic joint infection | NR | 3 | • Fever • Hypoxia requiring O2 |
• BAL = 14% • Peripheral eosinophilia • CT = patchy bilateral infiltrates |
• DAP d/c • Corticosteroids |
• Recovered after 5 days • Recurrent symptoms • Low dose steroids required |
| 87/M | Prosthetic knee infection | NR | 4 | • Dyspnea, dry cough requiring O2
• Malaise, chills, anorexia, fever |
• BAL = 40% • Peripheral eosinophilia • CT = bilateral patchy pulmonary infiltrates |
• DAP d/c • Corticosteroids |
• Recurrence s/p steroid taper • Low dose steroids for 2 years |
|
| Miller [11] (2010) | 60/M | MSSA prosthetic hip infection | 6 | 2 | • Cough, fever • Hypoxia requiring O2 |
• BAL = 81% after rechallenge • Peripheral eosinophilia • CT = bilateral scattered ground-glass opacities • Lung biopsy = acute fibrinous and organizing pneumonia, reactive alveolar and interstitial epithelial changes |
• DAP d/c • Rechallenged, DAP d/c • Corticosteroids |
• Improved within 48 h • Rechallenge failed within 24 h |
| 60/M | MRSA osteomyelitis, septic arthritis | 6 | 2 | • Non-productive cough, dyspnea • Low-grade fevers, chills |
• Peripheral eosinophilia • CT = patchy peripheral nodular/ground-glass |
• DAP d/c | • Resolution within 96 h • Recurrence with re-challenge at 5 months |
|
| 83/M | Diskitis of lumbar spine | 6 | 4 | • Progressive dyspnea, • Cough, pleuritic chest pain |
• BAL = 13% • Peripheral eosinophilia • CT = diffuse ground-glass, reticular opacities • Lung biopsy = acute organizing pneumonia, eosinophilia, chronic inflammation, fibro-inflammatory changes |
• DAP d/c • Corticosteroids |
Improved within 6 days | |
| Kalogeropoulous [12] (2011) | 78/M | Endocarditis | 8 | 1.4 | • Fever, chills, diaphoresis, • Hypoxemia requiring O2 |
• BAL = 27.5% • Peripheral eosinophilia • Elevated ESR • Elevated CRP • CT = patchy consolidation, ground-glass opacities, bilateral pleural effusions |
• DAP d/c | Resolution within 24 h |
| Rether [13] (2011) | 69/M | Spondylo-discitis with lumbar epidural and bilateral psoas abscesses | 6 | 3 | • Fever • Dyspnea requiring O2 |
• BAL = 30% • Elevated CRP • CXR = extensive patchy infiltrates in RLL and entire left lung |
• DAP d/c • Corticosteroids |
Improved within 24 h |
| Patel [14] (2014) | 61/F | Osteomyelitis | NR | 1 | • Dry cough • Dyspnea requiring MV |
• BAL = 30% • Peripheral eosinophilia • CT = bilateral pleural effusion, diffuse bilateral patchy infiltrate |
• DAP d/c • Corticosteroids |
Improved within 72 h |
| Phillips [15] 2014) | 48/M | Osteomyelitis | 6 | 3 | • Fever • Dyspnea requiring MV |
• BAL = 17% • Peripheral eosinophilia • CXR = patchy bilateral airspace opacities |
• DAP d/c • Corticosteroids |
• Improved |
| 28/M | Osteomyelitis | 6 | 4 | • Dyspnea requiring MV • Chest pain, light-headedness |
• BAL = 74% • Peripheral eosinophilia • CT = diffuse multi-lobar infiltrates |
• DAP d/c • Corticosteroids |
Resolution within 1 week | |
| Yamamoto [16] (2014) | 82/M | MRSA bacteremia | 10 | 2 | • Low grade fever • Hypoxia |
• CT = bilateral ground glass opacities • Sputum negative for eosinophils |
• DAP d/c | Improved |
| Yusuf [17] (2014) | 64/M | Prosthetic joint infection | 10 | 4 | • Fever | • BAL = 47% • Peripheral eosinophilia • Elevated CRP • CT = diffuse bilateral ground-glass opacities |
• DAP d/c | Improved within 24 h |
| 61/M | Prosthetic joint infection | 10 | 2 | • Fever • Dyspnea requiring MV |
• BAL = 3% • Peripheral eosinophilia • Elevated CRP • CT = ground-glass consolidation, bilateral pleural effusion |
• DAP d/c | Improved within 24 h | |
| Chiu [18] (2015) | 77/M | Osteomyelitis | 6 | 6 | • Pleuritic chest pain • Cough, dyspnea requiring O2 |
• BAL = 18% • Elevated CRP • CXR = diffuse bilateral airspace disease |
• DAP was d/c 1 day before symptoms • Corticosteroids |
Improved within 60 h |
| 74/F | Infected hip reconstruction | 6 | 1b | • Fever • Dyspnea requiring O2 |
• CXR – bilateral airspace disease | • DAP d/c • Corticosteroids |
Improved within 24 h | |
| Hagiya [19] (2015) | 34/M | Endocarditis | 10 | 1 | • Cough with mild hypoxemia | • Peripheral eosinophilia • Elevated CRP • CT = consolidation in peripheral field of right upper lobe |
• DAP d/c | Resolved within 6 weeks |
| Hatipoglu [20] (2015) | 67/F | MRSA diabetic foot ulcer | NRc | 3.3 | • Cough, dyspnea requiring BPAP • Fever, fatigue, decreased appetite |
• Peripheral eosinophilia • Elevated CRP • CT = right lobe infiltration |
• DAP d/c • Inhaled corticosteroids |
Improved within 72 h |
| Roux [21] (2015) | 67/M | MSSA prosthetic hip infection | 6 | 2.4 | • Dry cough, hypoxemia | • BAL = 10% • Peripheral eosinophilia • CT = diffuse alveolar and interstitial opacities |
• DAP d/c • Corticosteroids |
Improved within 96 h |
| Wojtaszczyk [22] (2015) | 76/M | Septic arthritis and pacemaker vegetation | NR | 2 | • Dyspnea requiring O2, cough • Fever, fatigue |
• BAL = 58% • Elevated CRP • CT = bilateral ground glass opacity, patchy consolidation |
• DAP d/c • Corticosteroids |
Resolved within 72 h |
| Akcaer [23] (2016) | 60/M | MSSA post-amputation abscess | 5 | 3.4 | • Tachypnea, hypoxia requiring O2 | • Peripheral eosinophilia • Elevated CRP • Elevated ESR • HRCT = right pleural effusion, bilateral tree-in-bud pattern, bilateral scattered ground-glass opacities |
• DAP d/c | Resolved within 72 h |
KEY: BAL bronchoalveolar lavage, BPAP bilevel positive airway, CPK creatine phosphokinase, CRP C-reactive protein, CT computed tomography scan, CXR chest x-ray, DAP daptomycin, d/c discontinued, ESR erythrocyte sedimentation rate, F female, HRCT high resolution computed tomography, M male, MRSA methicillin resistant Staphylococcus aureus, MSSA methicillin susceptible Staphylococcus aureus, MV mechanical ventilation, NR not reported, NSAID nonsteroidal anti-inflammatory drug, O 2 oxygen, RLL right lower lobe; s/p status post, wks weeks
a = DAP given for 1 week, then held for 2 weeks, and restarted. Symptom onset in 72 h after restarting, b = not included in analysis, c = DAP 500 mg/day given (dose mg/kg unknown)