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Hot Tub Lung: A Diagnostic Challenge.
Hassaan Yasin1, William E Mangano2, Paras Malhotra1
1Internal Medicine, West Virginia University - Charleston Division.
Cureus
|November 4, 2017
Summary
Hot tub lung (HTL), a hypersensitivity response to mycobacteria, can present unusually. This case highlights HTL with cavitary nodules, emphasizing diagnosis beyond typical findings.
Area of Science:
- Pulmonology
- Infectious Diseases
- Radiology
Background:
- Hot tub lung (HTL) is a granulomatous lung disease linked to hypersensitivity to non-tuberculous mycobacteria (NTM).
- Standard radiographic signs include diffuse micronodular or ground glass opacities.
- Diagnosis can be challenging with atypical presentations.
Observation:
- A 56-year-old immunocompetent woman presented with chronic dyspnea and cough.
- Radiography revealed subcentimeter cavitary nodules in the upper lung zones with mediastinal lymphadenopathy.
- Bronchoscopy identified Mycobacterium avium complex (MAC).
Findings:
- The patient's condition worsened despite antimycobacterial treatment.
- Complete resolution occurred after discontinuing hot tub use and initiating steroid therapy.
- This is the first reported case of HTL presenting as cavitary nodules with mediastinal lymphadenopathy.
Implications:
- Physicians should consider HTL in patients with cavitary lung nodules and mediastinal lymphadenopathy.
- Atypical radiographic findings necessitate a thorough exposure history, including hot tub use.
- Early identification and avoidance of the inciting agent are crucial for effective management of HTL.
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