A Case of Clarithromycin-induced Eosinophilic Pneumonia and Myocarditis

Abstract

Acute eosinophilic pneumonia (AEP) is a rare disease with unknown etiology that is characterised by pulmonary infiltration in radiography and eosinophilic infiltration into the lungs. Clarithromycin is a commonly used and well tolerated antibiotic. A 31-year-old male asthma patient was admitted with dyspnea, fever, and sputum. Despite the clarithromycin treatment the patient’s complaints worsened. Leukocytes was 23400/ml (eosinophil 8%). We re-applied ampicillin-sulbactam and clarithromycin. Since leukocytosis and fever were persisting, antibiotics were withdrawn and cefepim, teicoplanin, and ciprofloxacin were started. Because the patient developed chest pain and his dyspnea worsened, we diagnosed the patient with myocardititis after the cardiac evaluation. The tomography showed pleural effusion and consolidation. Sputum, blood, and tracheal aspirates showed no microorganism production. No parasites were found in feces, either. Leukocyte and eosinophil levels got worsened. The patient was then diagnosed with eosinophilic pneumonia. After methylprednisolon was administrated, laboratory, radiological, and clinical findings improved. This case suggests that eosinophilic pneumonia should be considered in the differential diagnosis of patients with pneumonia who do not respond to treatment. Key Words: Clarithromycin; Eosinophilic Pneumonia; Myocarditis