P95 | Not an infection, but a complication of antibiotic therapy: daptomycin acute eosinophilic pneumonia

F. Masi¹, G. Linsalata², C. Giani², R. Capecchi², S. Barsotti², G. Bini², F. Finizola², C. Cois², E. Citi², J. Rosada² | ¹University of Pisa, ²Medical Departament, Azienda USL Toscana Nord Ovest, Pisa, Italy

Background: Daptomycin therapy is a leading cause of acute eosinophilic pneumonia (AEP), a rare but significant condition in Internal Medicine. It can manifest as acute respiratory failure, fever, and eosinophilia.
Case report: Patient is a 78 years old woman admitted for antibiotic treatment of MSSA sepsis complicated by osteomyelitis, prosthetic aortic valve endocarditis, and lung abscesses. She was treated with daptomycin 700 mg/day and ceftaroline 600 mg x 3. Following the removal of the prosthetic valve, clinical improvement was observed, with a decrease in fever, leukocytosis, CRP/PCT, and improved respiratory function.After one week of antibiotic therapy, an increase in eosinophil count (19.6%, 2360/µL) and CRP levels (2 ->25 mg/dL) was noted. Due to suspicion of an allergic reaction, empiric steroid therapy was initiated. Bacterial, fungal, and helminthic infections were ruled out. Bronchoalveolar lavage revealed 81% of eosinophils.The patient experienced acute dyspnea, respiratory failure and fever during the night, which required NIMV. A CT scan showed multifocal pneumonia with both interstitial honeycombing and consolidations. Based on these findings, a diagnosis of AEP was made. Steroids were increased (methylprednisolone 1 mg/kg/day) and daptomycin was discontinued. Over the next three days, there was a rapid improvement which allowed for the suspension of NIMV and reduction of consolidations seen on the chest X-ray. Normalization of the eosinophil count was observed after just two day of steroid therapy. A chest X-ray performed one week later documented complete resolution of the AEP.