Kenmotsu Hirotsugu, Honda Atsuro, Baba Tomohisa, Matsumoto Yutaka, Shichi Izumi, Eto Takashi, Arai Kazumori
Department of Respiratory Medicine, Shizuoka General Hospital.
Nihon Kokyuki Gakkai Zasshi. 2005 Nov;43(11):689-92.
A 26-year-old man presented with complaints of exertional dyspnea and cough. The patient has already been given corticosteroids at a previous hospital. Chest CT revealed small centrilobular nodules with diffuse ground-glass opacities in both lungs. Lung biopsy specimens at thoracoscopy revealed non-necrotizing granulomas, patchy foci of mononuclear cell infiltration and fibrous thickening of alveolar septa, and Masson's bodies in bronchioles. Sputum culture showed the growth of Mycobacterium avium complex (MAC). Culture of water from the bath tub of his home showed MAC. Administration of antituberculous drugs and corticosteroids, and avoidance of bathing at home resulted in the improvement of his symptoms and CT findings. We believe the case is hypersensitivity pneumonitis to MAC in an immunocompetent patient, simulating hot tub lung. Hypersensitivity pneumonitis caused by MAC is rare in Japan.
一名26岁男性因劳力性呼吸困难和咳嗽前来就诊。该患者此前在其他医院已接受过皮质类固醇治疗。胸部CT显示双肺有小的小叶中心结节及弥漫性磨玻璃影。胸腔镜下肺活检标本显示非坏死性肉芽肿、单核细胞浸润的斑片状病灶、肺泡间隔纤维增厚以及细支气管内的马松小体。痰培养显示鸟分枝杆菌复合群（MAC）生长。其家中浴缸水样培养也显示有MAC。给予抗结核药物和皮质类固醇治疗，并避免在家中泡澡后，患者症状及CT表现有所改善。我们认为该病例是免疫功能正常患者对MAC的过敏性肺炎，类似热水浴缸肺。在日本，由MAC引起的过敏性肺炎较为罕见。
