Koschel D, Pietrzyk C, Sennekamp J, Müller-Wening D
Zusamklinik der LVA Schwaben, Zusmarshausen.
Pneumologie. 2006 May;60(5):285-9. doi: 10.1055/s-2006-932160.
There have been several recent reports of pulmonary disease resulting from exposure to Mycobacterium avium complex in indoor hot tubs. The disease is thought to be due either to infection or extrinsic allergic alveolitis (EAA). In this report we describe the case of a patient who developed episodes of fever, dyspnea and cough 4-6 hours after cleaning his indoor swimming pool. A diagnosis of EAA was made on finding a restrictive lung function pattern with gas exchange abnormalities, a predominant lymphocytosis in the bronchoalveolar lavage, diffuse ground-glass opacities in the lower lobes on high-resolution computer tomography, and specific IgG antibody activity to the swimming pool water. There was no precipitin reaction or specific IgG antibody activity to microbes extracted from the water. Interestingly, the water contained Mycobacterium avium complex (MAC) in huge amounts and in this case the histopathological features of the lung biopsy specimens differed from those seen in typical EAA, but were similar to those described in "hot tub lung" caused by mycobacteria. Solely by avoidance of cleaning the swimming pool, without any pharmacological treatment, the patient recovered completely within three months. To the best of our knowledge, this is the first report of EAA possibly associated with MAC exposure in a swimming pool environment.
最近有几篇关于在室内热水浴缸中接触鸟分枝杆菌复合体导致肺部疾病的报道。这种疾病被认为要么是感染所致，要么是外源性过敏性肺泡炎（EAA）。在本报告中，我们描述了一名患者的病例，该患者在清洁其室内游泳池4至6小时后出现发热、呼吸困难和咳嗽发作。通过发现具有气体交换异常的限制性肺功能模式、支气管肺泡灌洗中以淋巴细胞为主、高分辨率计算机断层扫描显示下叶弥漫性磨玻璃影以及对游泳池水的特异性IgG抗体活性，做出了EAA的诊断。对从水中提取的微生物没有沉淀反应或特异性IgG抗体活性。有趣的是，水中含有大量的鸟分枝杆菌复合体（MAC），在这种情况下，肺活检标本的组织病理学特征与典型EAA中所见不同，但与分枝杆菌引起的“热水浴缸肺”中描述的特征相似。仅通过避免清洁游泳池，在没有任何药物治疗的情况下，患者在三个月内完全康复。据我们所知，这是第一份关于可能与游泳池环境中MAC暴露相关的EAA的报告。
