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.
Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more
Subscribe for full-text access to content from 1998 forward and a host of useful features
Activate your current subscription (AMA members and current subscribers)
Purchase Online Access to this article for 24 hours
Thank you for submitting a comment on this article. It will be reviewed by JAMA Internal Medicine editors. You will be notified when your comment has been published. Comments should not exceed 500 words of text and 10 references.
Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.
* = Required Field
Disclosure of Any Conflicts of Interest*
Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited: 5
Customize your page view by dragging & repositioning the boxes below.
More Listings atJAMACareerCenter.com >
and access these and other features:
Enter your username and email address. We'll send you a link to reset your password.
Enter your username and email address. We'll send instructions on how to reset your password to the email address we have on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.