Summary

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.

Background

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 …