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嗜酸性粒细胞性肺炎:一例达托霉素所致肺损伤病例

Eosinophilic pneumonia: a case of daptomycin induced lung injury.

作者信息

Raman Vaishnavi, Chaudhary Isha, Shieh Sean

机构信息

Medstar Health, Maryland, United States.

Saba University School of Medicine, Saba, Dutch Caribbean, Netherlands.

出版信息

J Community Hosp Intern Med Perspect. 2021 Mar 23;11(2):280-285. doi: 10.1080/20009666.2021.1883813.

Abstract

Eosinophilic pneumonia is a category of lung diseases characterized by an increased number of eosinophils in alveolar spaces and interstitium. Acute cases are often caused by fungal infections, parasites, drugs or toxins and can present with respiratory failure. Daptomycin has been identified as one of the rare causes of acute eosinophilic pneumonia. We describe a case of an elderly man on daptomycin for MRSA endocarditis treatment who presented to the hospital with fevers and dyspnea within two weeks of daptomycin initiation. As an inpatient, he developed an increasing oxygen requirement necessitating intensive care unit management. Daptomycin cessation improved his symptoms and he was placed on a steroid taper. These findings suggested a diagnosis of daptomycin-induced eosinophilic pneumonia. However, the patient deteriorated and eventually passed away despite resuscitative efforts. This case highlights the importance of prompt identification of eosinophilic pneumonia, its potential severity and the need for more exploration regarding the timing of corticosteroid taper. This in turn will inform more effective approaches to this condition in the future.

摘要

嗜酸性粒细胞性肺炎是一类肺部疾病,其特征为肺泡腔和间质中嗜酸性粒细胞数量增加。急性病例常由真菌感染、寄生虫、药物或毒素引起,可表现为呼吸衰竭。达托霉素已被确定为急性嗜酸性粒细胞性肺炎的罕见病因之一。我们描述了一例老年男性患者,因耐甲氧西林金黄色葡萄球菌心内膜炎接受达托霉素治疗,在开始使用达托霉素两周内出现发热和呼吸困难而入院。住院期间,他对氧气的需求不断增加,需要重症监护病房进行管理。停用达托霉素后症状改善,他开始逐渐减量使用类固醇。这些发现提示诊断为达托霉素诱导的嗜酸性粒细胞性肺炎。然而,尽管进行了抢救,患者病情仍恶化,最终死亡。该病例强调了及时识别嗜酸性粒细胞性肺炎的重要性、其潜在的严重性以及对类固醇逐渐减量时机进行更多探索的必要性。这反过来将为未来更有效地治疗这种疾病提供指导。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/15e1/8043520/96cbb42c4315/ZJCH_A_1883813_F0001_OC.jpg

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