title: A case of hypercalcemia secondary to hot tub lung.
abstract: Hypersensitivity pneumonitis (HP) is a diffuse granulomatous lung disease resulting from inhalation of an antigen to which an individual has been previously sensitized. Hot tub lung is an increasingly common form of HP associated with inhalation of water aerosols containing Mycobacterium avium complex organisms that contaminate hot tub water. Granulomatous lung disorders, most classically sarcoidosis, have been associated with unregulated 1-α-hydroxylase expression by macrophages present in the granulomas, causing conversion of 25-OH-vitamin D to the active form of vitamin D, 1,25(OH)2 vitamin D, and, thus, hypercalcemia. To our knowledge, this is the first confirmed case of hypercalcemia secondary to elevated 1,25(OH)2 vitamin D levels associated with HP.
authors.affiliation: Department of Medicine, Beth Israel Deaconness Medical Center.
authors.forename: Jessica
authors.initials: J
authors.lastname: Donato
authors.affiliation: Department of Medicine, Beth Israel Deaconness Medical Center. Electronic address: ctphilli@bidmc.harvard.edu.
authors.forename: Colin T
authors.initials: CT
authors.lastname: Phillips
authors.affiliation: Department of Pulmonary and Critical Care Medicine, Beth Israel Deaconness Medical Center.
authors.forename: Adam W
authors.initials: AW
authors.lastname: Gaffney
authors.affiliation: Department of Pathology, Beth Israel Deaconness Medical Center.
authors.forename: Paul A
authors.initials: PA
authors.lastname: VanderLaan
authors.affiliation: Department of Pulmonary and Critical Care Medicine, Beth Israel Deaconness Medical Center; Department of Pulmonary Medicine, Harvard Vanguard Medical Associates, Boston, MA.
authors.forename: Majd
authors.initials: M
authors.lastname: Mouded
mesh_terms: D000368:Aged; D000542:Alveolitis, Extrinsic Allergic / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology*; D001494:Baths / Q000009:adverse effects*; D001707:Biopsy, Needle; D004417:Dyspnea / Q000175:diagnosis / Q000209:etiology; D006358:Hot Temperature; D006801:Humans; D006934:Hypercalcemia / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D007150:Immunohistochemistry; D008297:Male; D015270:Mycobacterium avium-intracellulare Infection / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology*; D011241:Prednisone / Q000627:therapeutic use; D013902:Radiography, Thoracic / Q000379:methods; D035583:Rare Diseases; D018570:Risk Assessment; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome; D014807:Vitamin D / Q000097:blood; D014871:Water Microbiology
chemical_list: D014807:Vitamin D; D011241:Prednisone