Sokolowsky N, Rolland L, Vandenhende M-A, Colin J-Y, Laurent F, Morlat P, Bonnet F, Beylot-Barry M
Service de dermatologie, hôpital Saint-André, CHU de Bordeaux, rue Jean-Burguet, 33076 Bordeaux, France.
Service de médecine interne et maladies infectieuses, hôpital Saint-André, CHU de Bordeaux, rue Jean-Burguet, 33076 Bordeaux, France.
Ann Dermatol Venereol. 2017 Apr;144(4):290-294. doi: 10.1016/j.annder.2016.10.002. Epub 2016 Nov 4.
Interstitial lung disease, cutaneous rash and elevated serum angiotensin converting enzyme (ACE) may suggest diagnoses other than sarcoidosis.
A 58-year-old man had presented dyspnoea for 2 years with increased angiotensin-converting enzyme, as well as an interstitial syndrome and micronodules. The possibility of sarcoidosis was raised. Systemic corticosteroids resulted in improvement of the dyspnoea although it recurred on dose reduction. We noted fluctuating eczematous macules of the limbs with a histology of aspecific folliculitis. The identification of Mycobacterium avium complex (MAC) in the bronchoalveolar wash prompted us to initiate antimycobacterial therapy, but this was to no avail. Review of the CT-scan and questioning of the patient (daily use of a Jacuzzi for 7 years) resulted in diagnosis of hypersensitivity pneumonitis due to MAC. The cutaneous lesions were taken to indicate "hot tub folliculitis". Discontinuation of hot-tub use and a short course of oral corticosteroids resulted in healing within 4 months, with no recurrence at 2 years.
HTL is a form of hypersensitivity pneumonitis due to the presence of MAC in the water of Jacuzzis. This condition regresses spontaneously without treatment on discontinuation of Jacuzzi use. Hot-tub folliculitis due to Pseudomonas aeruginosa (PA) presents as macules and papules on covered skin areas (swimsuit) within 48hours of bathing and often declines within 2 weeks.
Our case is original as regards the concomitant lung and cutaneous involvement associated with Jacuzzi use, with an immunoallergic mechanism for the MAC and probably an infectious mechanism for the PA.
间质性肺病、皮疹和血清血管紧张素转换酶（ACE）升高可能提示结节病以外的诊断。
一名58岁男性出现呼吸困难2年，血管紧张素转换酶升高，伴有间质性综合征和微小结节。结节病的可能性增加。全身使用皮质类固醇使呼吸困难有所改善，但减量时复发。我们注意到四肢有波动的湿疹样斑疹，组织学检查为非特异性毛囊炎。支气管肺泡灌洗中发现鸟分枝杆菌复合体（MAC）促使我们开始抗分枝杆菌治疗，但未成功。回顾CT扫描并询问患者（7年来每天使用按摩浴缸）后，诊断为MAC所致的过敏性肺炎。皮肤病变被认为是“热水浴缸毛囊炎”。停止使用热水浴缸并短期口服皮质类固醇后，4个月内愈合，2年无复发。
热水浴缸肺（HTL）是一种由于按摩浴缸水中存在MAC而导致的过敏性肺炎。这种情况在停止使用按摩浴缸后不经治疗可自行消退。铜绿假单胞菌（PA）引起的热水浴缸毛囊炎在沐浴后48小时内在覆盖皮肤区域（泳衣部位）出现斑疹和丘疹，通常在2周内消退。
我们的病例在与使用按摩浴缸相关的肺部和皮肤同时受累方面具有独特性，MAC可能存在免疫过敏机制，PA可能存在感染机制。
