Daptomycin associated eosinophilic pneumonia

Fernández-González, Raquel; Díaz López, María Dolores; Lorenzo Vizcaya, Ana María; González Noya, Amara

doi:10.1016/j.medcle.2019.10.023

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It can be primary (idiopathic) or secondary; secondary causes include treatment with daptomycin, a lipopeptide used to treat Gram-positive bacterial infections.<a class="elsevierStyleCrossRef" href="#bib0005">1</a> Here we present a case of AEP secondary to daptomycin treatment.This case involves a 92-year-old man, allergic to penicillin, hypertensive, diabetic and with chronic kidney disease. He was admitted to our center with acute cholecystitis and bacteremia due to Enterobacter aerogenes, and ciprofloxacin treatment was started. On the sixth day he started with a fever accompanied with shivering and feeling generally unwell. New blood cultures were obtained, and the physical examination revealed phlebitis in the inner elbow area of the left arm, so vancomycin was added to the initial antibiotic therapy. This was maintained when growth was seen in blood cultures of Staphylococcus aureus oxacillin sensitive (SAMS), with a MIC for vancomycin by E-test® of 1.5 mg/d. Despite antibiotic therapy, the patient continued with feverish peaks and growth of oxacillin-susceptible S. aureus in control cultures at 72 h, so the regimen was changed to daptomycin 10 mg/kg/day plus fosfomycin 2 g/6 h and complementary studies were requested. Henceforth he presented favorable clinical and laboratory progress, with negative control blood cultures, the echo-Doppler showing no signs of suppurative thrombophlebitis and the echocardiogram with no vegetations. So fosfomycin was suspended after one week, and the daptomycin was maintained.On the twelfth day of treatment with daptomycin, he began to present febrile peaks, associated with dyspnea and respiratory failure, without locating a focus and with negative successive cultures. An urgent CT scan was performed, which showed patchy consolidation areas associated with a reticular pattern in the middle lobe and lingula. With the suspicion of eosinophilic pneumonitis secondary to daptomycin, this drug was discontinued and a systemic corticosteroid was started. The patient remained afebrile from that moment forward, with progressive improvement in respiratory dynamics in the first 24 h, as well as radiological resolution of the infiltrates after one week. A bronchoscopy was not performed due to the patient's comorbidities, but he presented peripheral eosinophilia.AEP was first described in 1989, but it was in 1994 that Allen et al. established the diagnostic criteria for this syndrome: fever of at least 5 days, hypoxemia, diffuse alveolar or alveolar-interstitial infiltrates, and eosinophilia greater than 25% on BAL.<a class="elsevierStyleCrossRef" href="#bib0010">2</a> It is characterised by a condition which develops within one month (usually less than a week) of a non-productive cough (95%), dyspnea (92%), fever (88%), malaise, night sweats, chills and pleuritic pain.<a class="elsevierStyleCrossRef" href="#bib0015">3</a> The physical examination shows tachypnea and bibasal crackles. The laboratory tests usually show leucocytosis with neutrophilia, with subsequent appearance of peripheral eosinophilia; it can be associated with elevated CRP, IgE and/or ESR. In imaging it usually presents reticular or ground-glass opacities, predominantly in an apical location (50% of cases), and it can be migratory in up to 25%.<a class="elsevierStyleCrossRef" href="#bib0020">4</a>The aetiology can be primary (idiopathic), or secondary with the focus being placed on exposure to antibiotics (daptomycin, minocycline, nitrofurantoin), steroidal anti-inflammatory drugs (sulfasalazine, mesalazine), and anti-seizural drugs.According to papers published to date, daptomycin is one of the main causes of secondary AEP.<a class="elsevierStyleCrossRef" href="#bib0020">4</a> Since the approval for its use in soft tissue Gram-positive bacterial infections in September 2003, and the subsequent extension in 2006 to bacteremia by S. aureus its prescription has continued to expand. The first cases are reported in 2007<a class="elsevierStyleCrossRef" href="#bib0025">5</a> and since then 51 cases have been published. The diagnostic criteria according to the FDA guidelines are presented in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.<a class="elsevierStyleCrossRef" href="#bib0005">1</a> The pathophysiology is unclear; one theory is based on the accumulation of daptomycin hindering the production of surfactant causing damage and inflammation in the lung epithelium; another theory is that the detection of an antigen by alveolar macrophages leads to the recruitment of T-Helper 2 Lymphocytes, thus releasing IL-5 that promotes the production and migration of eosinophils to the lung.<a class="elsevierStyleCrossRef" href="#bib0025">5</a><elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Daptomycin AEP is a rare but serious entity. Its incidence continues to increase over the last few years, in parallel with the increase in the use of daptomycin. It is important to know about this adverse effect, since the diagnosis requires clinical suspicion, and it is essential to suspend the drug for its resolution." "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Fernández-González R, Díaz López MD, Lorenzo Vizcaya AM, González Noya A. Neumonitis eosinofílica por daptomicina. Med Clin (Barc). 2021;156:148–149." ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "BAL: bronchoalveolar lavage; FDA: Food and Drug Administration; X-ray: radiography; CT: computed tomography; NIMV: non-invasive mechanical ventilation." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Definitive \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Probable \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Possible \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Unlikely \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Concurrent exposure to daptomycin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Concurrent exposure to daptomycin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Concurrent exposure to daptomycin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">All other cases that did not meet criteria \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Dyspnea with increased oxygen requirement or NIMV \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Dyspnea with increased oxygen requirement or NIMV \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">New infiltrates on chest X-ray or CT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">New infiltrates on chest X-ray or CT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">New infiltrates on chest X-ray or CT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Clinical improvement following daptomycin withdrawal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">BAL > 25% eosinophils \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">BAL < 25% eosinophils or peripheral eosinophilia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Clinical improvement following daptomycin withdrawal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Clinical improvement following daptomycin withdrawal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Fever \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2514277.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Diagnostic criteria for eosinophilic pneumonitis associated with the use of daptomycin according to the FDA guidelines." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "FDA Drug And Safety Communication: Eosinophilic pneumonia associated with the use of Cubicin (daptomycin). Available from: <a target="_blank" href="https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/fda-drug-safety-communication-eosinophilic-pneumonia-associated-use-cubicin-daptomycin">https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/fda-drug-safety-communication-eosinophilic-pneumonia-associated-use-cubicin-daptomycin</a> [Accessed September 2019]." ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acute eosinophilic pneumonia as a reversible cause of noninfectious respiratory failure" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J.N. Allen" 1 => "E.R. Patch" 2 => "J.E. Gadek" 3 => "W.B. Davis" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "N Eng J Med." "fecha" => "1989" "volumen" => "321" "paginaInicial" => "569" "paginaFinal" => "574" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical characteristics and corticosteroid treatment of acute esinophilic pneumonia" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C.K. Rhee" 1 => "K.H. Min" 2 => "N.Y. Yim" 3 => "E.L. Ji" 4 => "R.L. Na" 5 => "P.C. Man" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Eur Respir J." "fecha" => "2013" "volumen" => "41" "paginaInicial" => "402" "paginaFinal" => "409" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Drug-induced eosinophilic pneumonia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "B. Carmi" 1 => "S. Iftach" 2 => "B. Leonid" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Medicine." "fecha" => "2018" "volumen" => "97" "paginaInicial" => "4" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Daptomycin-induced eosinophilic pneumonia—a systematic review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "P. Uppal" 1 => "K.L. LaPlante" 2 => "M.M. Gaitanis" 3 => "D.J. Matthew" 4 => "E.W. Kristina" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s13756-016-0158-8" "Revista" => array:5 [ "tituloSerie" => "Antimicrob Resist Infect Control." "fecha" => "2016" "volumen" => "5" "paginaInicial" => "55" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27999664" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000015600000003/v1_202102051000/S2387020620306422/v1_202102051000/en/main.assets" "Apartado" => array:4 [ "identificador" => "43309" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000015600000003/v1_202102051000/S2387020620306422/v1_202102051000/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020620306422?idApp=UINPBA00004N"]

ISSN: 2387-0206

Launched in 1943, Medicina Clínica is a fortnightly journal aimed at the promotion of clinical research and practice among internal medicine and other specialists. The key characteristics of Medicina Clínica are the scientific and methodological rigor of its manuscripts, the topicality of its contents, and, especially, its practical focus with highly useful information for clinical practice. Medicina Clínica is predominantly interested in publishing original research manuscripts, which are rigorously selected according to their quality, originality, and interest, and also in continued medical education-oriented manuscripts, which are commissioned by the journal to relevant authors (Editorials, Reviews, and Diagnosis and Treatment). These manuscripts contain updated topics with a major clinical or conceptual relevance in modern medicine. The journal adheres to the standards of academic research publications in all aspects including peer-review and ethical principles. Medicina Clínica is included in the General and Internal Medicine category of Thomson Reuters.

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Impact factor

The Impact Factor measures the average number of citations received in a particular year by papers published in the journal during the two preceding years.

© Clarivate Analytics, Journal Citation Reports 2022

Impact factor 2023

2.6

Citescore

CiteScore measures average citations received per document published.

Citescore 2023

3.1

SJR

SRJ is a prestige metric based on the idea that not all citations are the same. SJR uses a similar algorithm as the Google page rank; it provides a quantitative and qualitative measure of the journal's impact.

SJR 2023

0.371

SNIP

SNIP measures contextual citation impact by wighting citations based on the total number of citations in a subject field.

SNIP 2023

0.511

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Vol. 156. Issue 3.