We thank Travaline and Kelsen for publishing their report of another case of hot tub lung. Since the publication of our article,1 we have heard from other clinicians with similar cases. Given the popularity of indoor and outdoor hot tubs, the ubiquity of Mycobacterium avium complex and the ever-increasing number of reports of disease in immunocompetent hosts, it is very likely that hot tub lung, as a disease entity in general and due to Mycobacterium avium complex in specific, is an underappreciated and undiagnosed entity. We agree that physicians should query their patients who present with respiratory and constitutional symptoms about the use of a hot tub.
Schaefer OP, Cappelluti E, Fraire AE. Hypersensitivity Pneumonitis Associated With Hot Tub Use—Reply. Arch Intern Med. 2003;163(18):2250-2251. doi:10.1001/archinte.163.18.2250-a