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Table 2 Summary of 35 cases of presumed daptomycin-induced eosinophilic pneumonia

From: Daptomycin-induced eosinophilic pneumonia - a systematic review

Case Age/Sex Indication Dose (mg/kg/day) DAP Duration (wks) Clinical Findings Objective Findings Treatment Outcome
Kim [1] (2012) 63/F MSSA spinal osteomyelitis 6 3 • Fever
• Cough, hypoxemia
• BAL = 60–70%
• Peripheral eosinophilia
• Elevated CPK
• DAP d/c
• Corticosteroids
Recovered
64/M Osteomyelitis with bacteremia 5.7 4 • Fever
• Dyspnea, hypoxia
• BAL = 44%
• Peripheral eosinophilia
• Pulmonary infiltrates
• DAP d/c Recovered
79/M Endocarditis 6 6 • Fever, cough, night sweats
• Dyspnea requiring MV
• BAL = 9–13%
• Peripheral eosinophilia
• CT = ground glass opacities
• Lung biopsy = eosinophilic pneumonitis
• DAP d/c
• Corticosteroids
Improved
26/M MRSA bacteremia 7.35 1.4 • Dyspnea requiring MV • BAL not performed
• Peripheral eosinophilia
• Pulmonary infiltrates
• Eosinophils in tracheal aspirate
• DAP d/c Improved
43/M MRSA osteomyelitis 6 1–2 • Pleuritic pain
• Hypoxia requiring O2
• BAL not performed
• Peripheral eosinophilia
• CT = bilateral infiltrates
• DAP d/c
• Given NSAIDs, meperidine
• Improved
• Residual infiltrates on CT s/p 4 wks
66/M MSSA bacteremia 6 1 • Dyspnea requiring O2
• Hematemesis
• BAL with eosinophils (not quantified)
• Peripheral eosinophilia
• DAP d/c
• Corticosteroids
Recovered
71/M MRSA diabetic foot infection 4 7.7 • Dyspnea requiring O2 • Peripheral eosinophilia
• Elevated CRP
• Elevated ESR
• CT = bilateral interstitial opacities
• DAP d/c Improved
77/F Bacteremia (enterococcal) 5 1 • Dyspnea requiring O2 • Peripheral eosinophilia
• CXR = pneumonitis
• DAP d/c
• Corticosteroids
Improved
67/M MRSA endocarditis 6 4.3 • Dyspnea requiring MV • BAL = 9%
• Peripheral eosinophilia
• CT = bilateral pulmonary infiltrates
• DAP d/c
• Corticosteroids
Improved
73/M Prosthetic joint infection 5 3.7 • Fever
• Dyspnea requiring MV
• Peripheral eosinophilia
• CT = bilateral ground glass appearance
• DAP d/c
• Corticosteroids
Recovered
81/F MRSA paraspinal abscess 6 1.6 • Dyspnea requiring MV • BAL = 2% (s/p corticosteroid)a
• CXR = bilateral mid-lung infiltrates
• DAP d/c
• Corticosteroids
Improved
Cobb [6] (2007) 84/M Infection of left knee prosthesis 4 4 • Decreased appetite
• Weight loss
• Fatigue
• Weakness
• Elevated ESR
• CT with infiltrates
• Lung biopsy = eosinophilic pneumonia
• DAP d/c • Improved within 2 weeks
Hayes [7] (2007) 60/M MSSA endocarditis NR 2 • Fever, rigors, diaphoresis
• Required MV
• BAL 16% initially
• BAL 26% after rechallenge
• CRP elevated
• DAP d/c – then re-challenged
• DAP d/c plus corticosteroids
• Rechallenge failed within 4 h
• Improved within 24 h after DAP d/c
Kakish [8] (2008) 65/M MRSA vertebral osteomyelitis, epidural abscess 6 2 • Low-grade fever
• Dyspnea requiring MV
• BAL = 33%
• Peripheral eosinophilia
• Lung biopsy revealed eosinophils
• DAP d/c
• Corticosteroids
• Improved within 72 h
• Normal CT at 3 months
Shinde [9] (2009) 54/M Complicated inguinal hernia repair NR 2 • Low grade fever, cough
• Hypoxemia requiring MV
• Peripheral eosinophilia
• CT = bilateral airspace, peripheral predominance, small bilateral effusions
• Lung biopsy = many eosinophils
• DAP d/c
• Corticosteroids
• Improved within 24 h
• Normal CT at 4 weeks
Lal [10] (2010) 82/M Prosthetic joint infection NR 3 • Fever
• Hypoxia requiring O2
• BAL = 14%
• Peripheral eosinophilia
• CT = patchy bilateral infiltrates
• DAP d/c
• Corticosteroids
• Recovered after 5 days
• Recurrent symptoms
• Low dose steroids required
87/M Prosthetic knee infection NR 4 • Dyspnea, dry cough requiring O2
• Malaise, chills, anorexia, fever
• BAL = 40%
• Peripheral eosinophilia
• CT = bilateral patchy pulmonary infiltrates
• DAP d/c
• Corticosteroids
• Recurrence s/p steroid taper
• Low dose steroids for 2 years
Miller [11] (2010) 60/M MSSA prosthetic hip infection 6 2 • Cough, fever
• Hypoxia requiring O2
• BAL = 81% after rechallenge
• Peripheral eosinophilia
• CT = bilateral scattered ground-glass opacities
• Lung biopsy = acute fibrinous and organizing pneumonia, reactive alveolar and interstitial epithelial changes
• DAP d/c
• Rechallenged, DAP d/c
• Corticosteroids
• Improved within 48 h
• Rechallenge failed within 24 h
60/M MRSA osteomyelitis, septic arthritis 6 2 • Non-productive cough, dyspnea
• Low-grade fevers, chills
• Peripheral eosinophilia
• CT = patchy peripheral nodular/ground-glass
• DAP d/c • Resolution within 96 h
• Recurrence with re-challenge at 5 months
83/M Diskitis of lumbar spine 6 4 • Progressive dyspnea,
• Cough, pleuritic chest pain
• BAL = 13%
• Peripheral eosinophilia
• CT = diffuse ground-glass, reticular opacities
• Lung biopsy = acute organizing pneumonia, eosinophilia, chronic inflammation, fibro-inflammatory changes
• DAP d/c
• Corticosteroids
Improved within 6 days
Kalogeropoulous [12] (2011) 78/M Endocarditis 8 1.4 • Fever, chills, diaphoresis,
• Hypoxemia requiring O2
• BAL = 27.5%
• Peripheral eosinophilia
• Elevated ESR
• Elevated CRP
• CT = patchy consolidation, ground-glass opacities, bilateral pleural effusions
• DAP d/c Resolution within 24 h
Rether [13] (2011) 69/M Spondylo-discitis with lumbar epidural and bilateral psoas abscesses 6 3 • Fever
• Dyspnea requiring O2
• BAL = 30%
• Elevated CRP
• CXR = extensive patchy infiltrates in RLL and entire left lung
• DAP d/c
• Corticosteroids
Improved within 24 h
Patel [14] (2014) 61/F Osteomyelitis NR 1 • Dry cough
• Dyspnea requiring MV
• BAL = 30%
• Peripheral eosinophilia
• CT = bilateral pleural effusion, diffuse bilateral patchy infiltrate
• DAP d/c
• Corticosteroids
Improved within 72 h
Phillips [15] 2014) 48/M Osteomyelitis 6 3 • Fever
• Dyspnea requiring MV
• BAL = 17%
• Peripheral eosinophilia
• CXR = patchy bilateral airspace opacities
• DAP d/c
• Corticosteroids
• Improved
28/M Osteomyelitis 6 4 • Dyspnea requiring MV
• Chest pain, light-headedness
• BAL = 74%
• Peripheral eosinophilia
• CT = diffuse multi-lobar infiltrates
• DAP d/c
• Corticosteroids
Resolution within 1 week
Yamamoto [16] (2014) 82/M MRSA bacteremia 10 2 • Low grade fever
• Hypoxia
• CT = bilateral ground glass opacities
• Sputum negative for eosinophils
• DAP d/c Improved
Yusuf [17] (2014) 64/M Prosthetic joint infection 10 4 • Fever • BAL = 47%
• Peripheral eosinophilia
• Elevated CRP
• CT = diffuse bilateral ground-glass opacities
• DAP d/c Improved within 24 h
61/M Prosthetic joint infection 10 2 • Fever
• Dyspnea requiring MV
• BAL = 3%
• Peripheral eosinophilia
• Elevated CRP
• CT = ground-glass consolidation, bilateral pleural effusion
• DAP d/c Improved within 24 h
Chiu [18] (2015) 77/M Osteomyelitis 6 6 • Pleuritic chest pain
• Cough, dyspnea requiring O2
• BAL = 18%
• Elevated CRP
• CXR = diffuse bilateral airspace disease
• DAP was d/c 1 day before symptoms
• Corticosteroids
Improved within 60 h
74/F Infected hip reconstruction 6 1b • Fever
• Dyspnea requiring O2
• CXR – bilateral airspace disease • DAP d/c
• Corticosteroids
Improved within 24 h
Hagiya [19] (2015) 34/M Endocarditis 10 1 • Cough with mild hypoxemia • Peripheral eosinophilia
• Elevated CRP
• CT = consolidation in peripheral field of right upper lobe
• DAP d/c Resolved within 6 weeks
Hatipoglu [20] (2015) 67/F MRSA diabetic foot ulcer NRc 3.3 • Cough, dyspnea requiring BPAP
• Fever, fatigue, decreased appetite
• Peripheral eosinophilia
• Elevated CRP
• CT = right lobe infiltration
• DAP d/c
• Inhaled corticosteroids
Improved within 72 h
Roux [21] (2015) 67/M MSSA prosthetic hip infection 6 2.4 • Dry cough, hypoxemia • BAL = 10%
• Peripheral eosinophilia
• CT = diffuse alveolar and interstitial opacities
• DAP d/c
• Corticosteroids
Improved within 96 h
Wojtaszczyk [22] (2015) 76/M Septic arthritis and pacemaker vegetation NR 2 • Dyspnea requiring O2, cough
• Fever, fatigue
• BAL = 58%
• Elevated CRP
• CT = bilateral ground glass opacity, patchy consolidation
• DAP d/c
• Corticosteroids
Resolved within 72 h
Akcaer [23] (2016) 60/M MSSA post-amputation abscess 5 3.4 • Tachypnea, hypoxia requiring O2 • Peripheral eosinophilia
• Elevated CRP
• Elevated ESR
• HRCT = right pleural effusion, bilateral tree-in-bud pattern, bilateral scattered ground-glass opacities
• DAP d/c Resolved within 72 h
  1. KEY: BAL bronchoalveolar lavage, BPAP bilevel positive airway, CPK creatine phosphokinase, CRP C-reactive protein, CT computed tomography scan, CXR chest x-ray, DAP daptomycin, d/c discontinued, ESR erythrocyte sedimentation rate, F female, HRCT high resolution computed tomography, M male, MRSA methicillin resistant Staphylococcus aureus, MSSA methicillin susceptible Staphylococcus aureus, MV mechanical ventilation, NR not reported, NSAID nonsteroidal anti-inflammatory drug, O 2 oxygen, RLL right lower lobe; s/p status post, wks weeks
  2. a = DAP given for 1 week, then held for 2 weeks, and restarted. Symptom onset in 72 h after restarting, b = not included in analysis, c = DAP 500 mg/day given (dose mg/kg unknown)