Yordanka Diaz Saez, Allena Nishant, Doddi Swetha, Patel Harish, Pandey Neelanjana, Vakde Trupti
Pulmonary and Critical Care Medicine, BronxCare Health System, Bronx, USA.
Internal Medicine, BronxCare Health System, Bronx, USA.
Cureus. 2025 Apr 29;17(4):e83195. doi: 10.7759/cureus.83195. eCollection 2025 Apr.
Pulmonary infiltrates, arising from diverse etiologies such as infections, cardiac conditions, or parenchymal diseases, present a diagnostic challenge. Drug-induced pneumonitis, although less common, should be considered, especially when symptoms develop after medication initiation. This case report highlights a rare yet significant complication of antibiotic therapy, daptomycin-induced eosinophilic pneumonia (DIEP). A 56-year-old male with a history of type 2 diabetes mellitus, hypertension, and renal insufficiency presented with pleuritic chest pain and a productive cough for two days. Chest X-ray and CT imaging revealed bilateral scattered airspace opacities and ground-glass opacities, suggesting pneumonia or pulmonary edema. Initially treated for healthcare-associated pneumonia, the patient's condition persisted despite therapy. His medical history included osteomyelitis treated with vancomycin, later switched to daptomycin. Two weeks after the switch, the patient developed new respiratory symptoms. A bronchoalveolar lavage (BAL) was performed to establish the diagnosis of eosinophilic pneumonia. BAL showed >25% eosinophils, confirming daptomycin-induced eosinophilic pneumonia. The antibiotic was discontinued, and prednisone 40 mg daily was initiated, leading to the resolution of symptoms. Daptomycin, an antibiotic commonly used to treat gram-positive infections, can rarely cause eosinophilic pneumonia, a rare adverse reaction characterized by pleuritic chest pain, dyspnea, and diffuse ground-glass opacities on imaging. The mechanism remains unclear but may involve surfactant binding, leading to alveolar epithelial injury. Diagnosis is confirmed through BAL, with eosinophilia greater than 25%. Management consists of discontinuing daptomycin and initiating steroids if necessary. This case underscores the importance of early recognition and prompt discontinuation of the offending drug, along with the use of steroids in cases with severe symptoms. BAL is a key diagnostic tool in confirming drug-induced eosinophilic pneumonia. In conclusion, daptomycin-induced eosinophilic pneumonia is a rare but significant complication requiring vigilance in patients treated with the drug. Early diagnosis and effective management are crucial for achieving favorable outcomes.
肺部浸润由多种病因引起，如感染、心脏疾病或实质性疾病，这给诊断带来了挑战。药物性肺炎虽不太常见，但也应予以考虑，尤其是在用药后出现症状的情况下。本病例报告强调了抗生素治疗一种罕见但严重的并发症，即达托霉素诱导的嗜酸性粒细胞性肺炎（DIEP）。一名56岁男性，有2型糖尿病、高血压和肾功能不全病史，出现胸膜炎性胸痛和咳痰2天。胸部X线和CT成像显示双侧散在的气腔实变和磨玻璃影，提示肺炎或肺水肿。最初按医疗保健相关肺炎进行治疗，尽管进行了治疗，患者病情仍持续。他的病史包括用万古霉素治疗的骨髓炎，后来改用达托霉素。换药两周后，患者出现了新的呼吸道症状。进行了支气管肺泡灌洗（BAL）以确诊嗜酸性粒细胞性肺炎。BAL显示嗜酸性粒细胞>25%，证实为达托霉素诱导的嗜酸性粒细胞性肺炎。停用抗生素，并开始每日服用40mg泼尼松，症状得以缓解。达托霉素是一种常用于治疗革兰氏阳性感染的抗生素，很少会引起嗜酸性粒细胞性肺炎，这是一种罕见的不良反应，其特征为胸膜炎性胸痛、呼吸困难以及影像学上的弥漫性磨玻璃影。其机制尚不清楚，但可能涉及表面活性剂结合，导致肺泡上皮损伤。通过BAL确诊，嗜酸性粒细胞增多大于25%。处理措施包括停用达托霉素，必要时开始使用类固醇。本病例强调了早期识别和及时停用致病药物的重要性，以及在症状严重的病例中使用类固醇的重要性。BAL是确诊药物性嗜酸性粒细胞性肺炎的关键诊断工具。总之，达托霉素诱导的嗜酸性粒细胞性肺炎是一种罕见但严重的并发症，在用该药物治疗的患者中需要保持警惕。早期诊断和有效管理对于取得良好预后至关重要。
