Daptomycin-Induced Acute Generalized Exanthematous Pustulosis
Daptomycin is an antibiotic that is increasingly being prescribed for the treatment of gram-positive infections in conditions such as endocarditis, bacteremia, and soft tissue infections. Dermatologic adverse effects associated with daptomycin are not uncommon. Approximately 6.7% of patients taking daptomycin have been reported to develop a rash, and 5.8% have developed pruritus. As the popularity of daptomycin increases for the treatment of drug-resistant Staphylococcus aureus and Enterococcus infections, it is important for physicians to be aware of the potential dermatologic complications that may be associated with the use of this novel antibiotic in clinical practice.
Our case of a pustular eruption associated with the use of daptomycin is unique. In our patient, the clinical and histologic presentation was consistent with the diagnosis of AGEP. Based on the patient’s history of starting daptomycin 4 days prior to the onset of symptoms, we believe that the drug was associated with the development of AGEP. She had not recently undergone any other medication changes, as she had been taking her other medications for at least 3 years with the exception of warfarin and oxycodone hydrochloride, which were initiated 5 weeks prior to the eruption.
Because of its unique mechanism of action as well as the prevalent phenomenon of antibiotic resistance, daptomycin is increasingly used for the treatment of complicated skin and skin structure infections caused by gram-positive organisms. As the use of daptomycin increases, it is important for physicians to be aware of its potential cutaneous complications.
