Storandt Michael H, Matta Abhishek
Internal Medicine, University of North Dakota School of Medicine, Grand Forks, USA.
Internal Medicine, University of North Dakota School of Medicine, Fargo, USA.
Cureus. 2020 Jan 28;12(1):e6803. doi: 10.7759/cureus.6803.
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.
达托霉素是一种环状脂肽类抗生素，对革兰氏阳性球菌具有高效，包括耐甲氧西林金黄色葡萄球菌和耐万古霉素肠球菌。急性嗜酸性粒细胞性肺炎是达托霉素治疗的一种罕见并发症，其病因尚不清楚，认为与药物在肺表面活性物质中蓄积导致炎症有关。我们报告一例56岁男性，有脊柱硬膜外脓肿病史，正在接受静脉注射达托霉素治疗，因发热到急诊科就诊，出现进行性加重的气短，随后通过支气管肺泡灌洗发现肺分泌物嗜酸性粒细胞增多。停用达托霉素，他接受了糖皮质激素治疗，症状完全缓解。急性嗜酸性粒细胞性肺炎的诊断需要高度的临床怀疑。由于症状可在开始治疗后的数天至数周内出现，这可能会使诊断更加复杂。这种并发症对糖皮质激素治疗和停用达托霉素反应良好，但认识到这一点至关重要。随着抗生素耐药性不断出现，达托霉素的使用日益增加，医生必须了解达托霉素治疗的这种罕见并发症。
