Rickman Otis B, Ryu Jay H, Fidler Mary E, Kalra Sanjay
Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minn 55905, USA.
Mayo Clin Proc. 2002 Nov;77(11):1233-7. doi: 10.4065/77.11.1233.
Many diseases, mainly infectious and inhalational, have been associated with the use of hot tubs. "Hot tub lung" is a recently described disease entity associated with Mycobacterium avium complex (MAC) and is thought to be either an infection or a hypersensitivity pneumonitis. We describe 2 patients with progressively worsening respiratory symptoms and pulmonary function, along with diffuse radiographic changes consisting primarily of ground-glass opacities. Treatment with corticosteroids, based on lung biopsies suggesting sarcoidosis in 1 patient and eosinophilic bronchiolitis in the other, resulted in little improvement with both patients experiencing respiratory failure. Both patients continued regular and continued hot tub use despite ongoing respiratory difficulties, and MAC was identified in the hot tub water and/or lung tissue from each patient. Discontinuation of hot tub use, without antimycobacterial therapy, led to prompt improvement in symptoms, pulmonary function, and radiographic abnormalities, strongly supporting a diagnosis of hypersensitivity pneumonitis. Hypersensitivity to MAC, rather than an infection, is the likely underlying mechanism in these 2 cases of hot tub lung.
许多疾病，主要是传染病和吸入性疾病，都与热水浴缸的使用有关。“热水浴缸肺”是一种最近描述的与鸟分枝杆菌复合体（MAC）相关的疾病实体，被认为是一种感染或过敏性肺炎。我们描述了2例呼吸症状和肺功能逐渐恶化的患者，同时伴有主要由磨玻璃影组成的弥漫性影像学改变。根据肺活检结果，1例患者提示为结节病，另1例为嗜酸性细支气管炎，给予糖皮质激素治疗，但效果不佳，两名患者均出现呼吸衰竭。尽管呼吸困难持续存在，两名患者仍继续定期使用热水浴缸，且在每位患者的热水浴缸水和/或肺组织中均检测到MAC。在未进行抗分枝杆菌治疗的情况下，停止使用热水浴缸后，症状、肺功能和影像学异常迅速改善，有力地支持了过敏性肺炎的诊断。在这2例热水浴缸肺病例中，对MAC的超敏反应而非感染可能是潜在机制。
