Abstract
Hot tub lung (HTL) is a granulomatous lung disease thought to occur as a result of a hypersensitivity response to non-tuberculous mycobacteria (NTM). Typical radiographic findings are diffuse micronodular and/or ground glass opacities. We report an interesting case of HTL that presented with unique radiographic features, making its diagnosis a predicament. A 56-year-old immunocompetent female with chronic dyspnea and dry cough was found to have subcentimeter cavitary nodules, predominantly in the upper lung zones. Tissue culture obtained via bronchoscopy was positive for Mycobacterium avium complex (MAC). The patient’s clinical and radiographic status, however, deteriorated on antimycobacterial therapy. Complete clinical and radiographic resolution was achieved only after avoidance of hot tub use and treatment with steroids. We believe this is the first reported case of HTL manifesting as cavitary lung nodules with mediastinal lymphadenopathy, and we recommend physicians keep HTL in consideration when encountering patients with these radiographic findings.
Highlights
Hot tub lung (HTL) is a diffuse granulomatous lung disease that occurs as a result of exposure to non-tuberculous mycobacteria (NTM) [1]
The patient’s clinical and radiographic status worsened despite being on antimycobacterial therapy for an adequate length of time, and significant improvement was only achieved with avoidance of hot tub exposure, which is a hallmark characteristic of hypersensitivity pneumonitis (HP)
Another interesting radiographic finding in our case was the development of mediastinal lymphadenopathy that complicated the clinical picture even further as it has not been reportedly seen with HTL [6]
Summary
Hot tub lung (HTL) is a diffuse granulomatous lung disease that occurs as a result of exposure to non-tuberculous mycobacteria (NTM) [1]. She was a former smoker with a past medical history of coronary artery disease, chronic obstructive pulmonary disease, and type 2 diabetes mellitus. A computed tomography (CT) of the chest was obtained which showed subcentimeter cavitary nodular lesions (Figure 1). The initial diagnosis was revisited and further history obtained from the patient revealed the regular use of a hot tub at home. She was advised complete avoidance of the hot tub. At one month follow-up, she reported significant improvement in her symptoms and a diagnosis of HTL was made. Thereafter, there was continued improvement in her clinical symptoms, and repeat imaging demonstrated complete resolution of the cavitary lesions and lymphadenopathy (Figure 5)
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