Daptomycin-induced pulmonary eosinophilia: early identification of antibiotic side effects

A man in his mid-80s with a history of heart failure presented with new onset cough, dyspnoea, opacities/infiltrates and oxygen requirement after 16 days of daptomycin use for methicillin-resistant Staphylococcus aureus bacteraemia. His symptoms did not respond to appropriate diuresis. He experienced an improvement in symptoms and eventually resolution after discontinuation of daptomycin and replacement with vancomycin for continued treatment of his bacteraemia. He was determined to have probable daptomycin-induced acute eosinophilic pneumonia, a rare side effect of daptomycin use, based on clinical presentation, peripheral eosinophilia correlated with daptomycin use, risk factors and resolution of symptoms following discontinuation of daptomycin.