Tsuchiya Noriko, Takayanagi Noboru, Yoneda Kouichiro, Miyahara Yousuke, Morokawa Nasa, Yamaguchi Shozaburo, Tokunaga Daidou, Saito Hiroo, Ubukata Mikio, Kurashima Kazuyoshi, Yanagisawa Tsutomu, Sugita Yutaka, Kawabata Yoshinori
Department of Respiratory Medicine.
Nihon Kokyuki Gakkai Zasshi. 2008 Sep;46(9):726-31.
A 49-year-old woman presented with exertional dyspnea. Chest CT revealed patchy areas of ground-glass attenuation and ill-defined centrilobular nodules scattered in both lungs. Bronchoalveolar lavage (BAL) fluid showed lymphocytosis. Transbronchial lung biopsy revealed bronchiolocentric alveolitis and well-formed non-necrotizing granulomas were present. She had used a jet bath before the onset of symptoms and mycobacterial culture revealed the presence of Mycobacterium avium complex (MAC) in sputum sample, BAL samples and jet bath water. Restriction fragment length polymorphism (RFLP) analysis revealed that the isolated MAC were essentially clonal. She had used the jet bath for the inhalation provocation study, and after the challenge she complained of dyspnea and have body temperature increased. We diagnosed hot tub lung due to Mycobacterium avium complex. Because avoidance of the jet bath caused improvement of her symptoms and reduced her fever and PaO2 increased by 10 Torr but did not improve the CT findings, antimycobacterial drugs were prescribed. The patient recovered fully. This case proves that the cause of hot tub lung is the use of jet bath through the inhalation provocation study.
一名49岁女性因劳力性呼吸困难就诊。胸部CT显示双肺散在斑片状磨玻璃影及边界不清的小叶中心结节。支气管肺泡灌洗（BAL）液显示淋巴细胞增多。经支气管肺活检显示为支气管中心性肺泡炎，可见成熟的非坏死性肉芽肿。患者在症状出现前使用过喷射浴缸，分枝杆菌培养显示痰标本、BAL标本及喷射浴缸水中均存在鸟分枝杆菌复合群（MAC）。限制性片段长度多态性（RFLP）分析显示分离出的MAC基本为克隆性。患者曾使用喷射浴缸进行吸入激发试验，激发后出现呼吸困难且体温升高。我们诊断为鸟分枝杆菌复合群所致的热水浴缸肺。由于避免使用喷射浴缸后症状改善、发热减轻且动脉血氧分压升高10 Torr，但CT表现未改善，遂给予抗分枝杆菌药物治疗。患者完全康复。该病例通过吸入激发试验证明热水浴缸肺的病因是使用喷射浴缸。
