Purpose: A case of eosinophilic pneumonia in a patient receiving ceftaroline for the treatment of methicillin-resistant Staphylococcus aureus (MRSA) pneumonia is reported.
Summary: A 65-year-old woman was admitted to a medical intensive care unit after arriving at the emergency room with complaints of progressively worsening shortness of breath. Her medical history included chronic obstructive pulmonary disease, acute respiratory distress syndrome, recent traumatic brain injury, tobacco use, and alcohol abuse. Within the first few days of hospitalization, the patient was diagnosed with MRSA pneumonia based on microbiological data from bronchoscopy bronchial washings. Her renal function liver enzyme levels were within normal limits. Empirical antibiotic therapy included i.v. vancomycin and meropenem and was narrowed to i.v. linezolid monotherapy based on culture and sensitivity results. After 10 days of treatment with linezolid, the patient was persistently febrile, and cultures remained positive. It was decided to switch therapy to a course of i.v. ceftaroline, an anti-MRSA cephalosporin. On the fifth day of treatment with ceftaroline, the patient developed respiratory decompensation and peripheral eosinophilia of 40%. Bronchoalveolar lavage (BAL) results indicated the presence of pulmonary eosinophilia of 13%. Chest radiographs revealed pulmonary infiltrates, and the computed tomography angiography showed no evidence of pulmonary embolism. Ceftaroline was discontinued, and the patient was started on vancomycin and methylprednisolone. The patient responded to methylprednisolone therapy, with repeat BAL and peripheral blood counts showing resolved eosinophilia.
Conclusion: A patient with risk factors for respiratory disease developed eosinophilic pneumonia after receiving ceftaroline for the treatment of MRSA pneumonia. Eosinophilia resolved after ceftaroline was discontinued and i.v. methylprednisolone was initiated.