Acute respiratory failure due to daptomycin induced eosinophilic pneumonia

Daptomycin is an antibiotic that is being used with increasing frequency for the treatment of methicillin resistant Staphylococcus aureus (MRSA) infections. We report a 65-year-old male patient with vertebral osteomyelitis due to MRSA who developed acute respiratory failure secondary to eosinophilic pneumonia after starting daptomycin therapy. Bronchoscopy showed a bronchoalveolar lavage (BAL) with 33% eosinophilia and the transbronchial biopsies revealed organizing pneumonia with many eosinophils. The patient responded rapidly to drug cessation and steroid therapy. Eosinophilic pneumonia is a rare but potentially serious complication of daptomycin therapy that, if recognized early, responds quickly to drug cessation and steroid therapy.