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Editor's Correspondence
October 13, 2003

Hypersensitivity Pneumonitis Associated With Hot Tub Use

Arch Intern Med. 2003;163(18):2250. doi:10.1001/archinte.163.18.2250-a

We read with great interest the case report of "hot tub lung" due to Mycobacterium avium complex in an immunocompetent host1 and wish to share our experience of a husband and wife who nearly simultaneously presented with symptoms that we believe represent hypersensitivity pneumonitis from hot tub use.

A 57-year-old man and his 56-year-old wife presented with nonproductive cough, low-grade fever, and breathlessness of approximately 2 months' duration. The husband was treated with antibiotics without change in symptoms. A chest radiograph revealed right upper-lobe infiltrates. A computed tomographic scan of the thorax showed diffuse bilateral ground-glass densities consistent with alveolitis. His symptoms became more severe. Another course of antibiotics failed to alter the clinical course, and he was empirically started on prednisone therapy. Transbronchial lung biopsy revealed multiple, poorly formed, noncaseating granuloma and acute inflammatory cells surrounding the airways consistent with hypersensitivity pneumonitis. Special stains for acid fast bacilli were negative. The wife presented to their physician a few weeks later with a similar constellation of symptoms. She was promptly started on prednisone therapy and did not have a lung biopsy. Her computed tomographic scan suggested small airways disease and revealed bilateral subcentimeter nodules.

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