Tuberc Respir Dis.  2009 Jan;66(1):37-41.

Two Cases of Hot Tub Lung in Bodyscrubbers Working in a Public Bath

• Bak JY
• Kim KS
• Park IN
• Yum HK
• Lee SH
• Lee HK
• Lee YM
• Jung H
• Hur JW
• Lee SS
• Lee HP
• Choi SJ
• Shin EA
• Choi SB

Abstract

Hot tub lung has been described as a pulmonary illness associated with exposure to nontuberculous mycobacteria, mainly hot bathtub water contaminated with Mycobacterium avium complex (MAC) and hence the name. Although not entirely clear, its etiology has been thought to involve either an infection or a hypersensitivity pneumonitis secondary to MAC. Herein, we describe 2 female patients (60 and 53 years old) admitted to our hospital with hot tub lung, and both of whom worked in a public bath. Both women were initially admitted following several months of exertional dyspnea and cough. The patients had been working as body-scrubbers in a public bath for several years. Their chest CT scans showed bilateral diffuse ground-glass opacities with multifocal air-trappings and poorly defined centrilobular nodules in both lungs. Pathological findings from lung specimens revealed small non-necrotizing granuloma in the lung parenchyme with relatively normal-looking adjacent alveoli. Discontinuation of working in the public bath led to an improvement in symptoms and radiographic abnormalities, without antimycobacterial therapy.

Keyword

Hypersensitivity pneumonitis; Hot tub; Nontuberculous mycobacteria; Granulomatous lung disease

MeSH Terms

Alveolitis, Extrinsic Allergic
Baths
Cough
Dyspnea
Female
Granuloma
Humans
Lung
Mycobacterium avium Complex
Nontuberculous Mycobacteria
Thorax

Figure

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  Figure 1 Chest X-ray on admission shows ground glass opacities in both lungs with decreased lung volume.

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  Figure 2 Chest CT scan shows bilateral diffuse ground glass opacities with multifocal air-trapping and poorly defined centrilobular nodules in both lungs.

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  Figure 3 Left lung flouro-guided biopsy. Microscopic findings reveal (A) a small non-necrotizing granuloma in the lung parenchyme with relatively normal-looking adjacent alveoli (H&E stain, ×40) and (B) central epitheloid histiocytic aggregation with surrounding cuff of lymphoplasmacytic infiltrates (H&E stain, ×100).

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  Figure 4 Chest CT scan shows bilateral diffuse ground glass opacities and tiny nodular infiltration on both lungs.

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