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Acute eosinophilic pneumonia-like syndrome post-initiation of vortioxetine
  1. Tanya Marie O'Brien
  1. Pharmacy, Eastern Health, St. John's, Newfoundland and Labrador, Canada
  1. Correspondence to Tanya Marie O'Brien; tanya.obrien{at}

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In conjunction with BMJ Case Reports, DTB will feature occasional drug-related cases that are likely to be of interest to readers. These will include cases that involve recently marketed drugs for which there is limited knowledge of adverse effects and cases that highlight unusual reactions to drugs that have been marketed for several years.


A man in his mid-30s presented to the emergency department with a 1-week history of fatigue, loss of appetite, fever and productive (yellow) cough. This progressed to requiring admission to intensive care needing a oxygen therapy via high-flow nasal cannula for acute hypoxaemic respiratory failure. He had recently started vortioxetine for major depressive disorder, and his acute symptoms correlated with an increase in the dose of vortioxetine. For more than 20 years, rare but consistent reports of serotonergic medications have been implicated in eosinophilic pulmonary conditions. During this same period, serotonergic medications have become a mainstay solution for a wide range of depressive symptoms and disorders. This is the first report of an eosinophilic pneumonia-like syndrome occurring while consuming the novel serotonergic medication vortioxetine.


Eosinophilic pneumonia is a variety of syndromes characterised by pulmonary infiltrates with accumulation of eosinophils in the lung interstitium, alveoli and, usually, peripheral blood eosinophilia. Clinical severity is variable, ranging from simple eosinophilic lung disease (Loeffler’s syndrome) to acute eosinophilic pneumonia (AEP) characterised by fever, rapid onset of respiratory symptoms and patchy, often bilateral, lung infiltrates in the chest roentgenogram, which can lead to a fulminant respiratory failure.1 The defining characteristics needed for the diagnosis of pulmonary eosinophilia include either peripheral blood eosinophilia with radiographically or tomographically identified pulmonary abnormalities, lung tissue eosinophilia demonstrated in transbronchial or open lung biopsies or increased eosinophils in bronchoalveolar lavege (BAL) fluid.2

Vortioxetine is a novel antidepressant drug approved for the treatment of major …

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  • Contributors TMO is the sole contributor of this paper.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.