Hankwitz Paul E, Cervia Joseph Steven, Thomas Charles F, Fink Jordan N, Marras Ted, Tomic Rade
Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
BMJ Case Rep. 2011 Jul 28;2011:bcr0620114360. doi: 10.1136/bcr.06.2011.4360.
A 57-year-old physician with increasing dyspnoea and hypoxaemia had a high-resolution CT scan of the chest, which disclosed diffuse pulmonary ground glass opacities, more pronounced in the upper lobes with minimal mediastinal lymphadenopathy. Transbronchial biopsy of the right middle and lower lobes was performed, demonstrating varying degrees of well circumscribed organising granulomatous pneumonitis thought to be most consistent with hypersensitivity to nontuberculous mycobacteria. Cultures of water obtained from the patient's home shower were positive for Mycobacterium avium complex. The patient began substituting baths for showers, experiencing some gradual improvement of his symptoms. Subsequently, he installed point-of-use 0.2 micron membrane filters on his shower, and resumed regular showering after installation with continued symptomatic improvement. CT scans at 3 and 18 months revealed improvement and resolution, respectively. Four years later, he continues to shower in filtered home shower water and remains clinically well.
一名57岁的医生出现进行性呼吸困难和低氧血症，接受了胸部高分辨率CT扫描，结果显示双肺弥漫性磨玻璃影，上叶更为明显，纵隔淋巴结肿大不明显。对右中叶和下叶进行了经支气管活检，结果显示不同程度的边界清晰的机化性肉芽肿性肺炎，认为最符合对非结核分枝杆菌的超敏反应。从患者家中淋浴器获取的水样培养出鸟分枝杆菌复合群。患者开始用盆浴代替淋浴，症状逐渐有所改善。随后，他在淋浴器上安装了使用点0.2微米膜过滤器，安装后恢复正常淋浴，症状持续改善。3个月和18个月时的CT扫描分别显示病变改善和消退。四年后，他继续使用过滤后的家中淋浴水淋浴，临床状况良好。
