title: Mycobacterium phocaicum and Mycobacterium avium-intracellulare in a patient with hot tub lung.
abstract: A 77-year-old woman who used her spa pool at least twice a day to relieve pain from osteoarthritis, developed progressive breathlessness, impaired pulmonary function, and radiographic changes consistent with hypersensitivity pneumonitis-like lung disease. M ycobacterium avium-intracellulare complex (MAC) was cultured from bronchoalveolar lavage fluid. Transbronchial biopsies revealed non-necrotizing granulomatous inflammation. Sputum and spa pool water cultured M ycobacterium phocaicum but not MAC. She stopped using the spa pool and was treated with oral prednisone, which led to symptomatic, pulmonary function, and radiographic improvement. This is the first case of hypersensitivity pneumonitis-like granulomatous lung disease associated with exposure to M . phocaicum in spa pool water.
authors: Medicine Department, Middlemore Hospital Auckland, New Zealand.
authors: James
authors: J
authors: Wethasinghe
authors: Respiratory Medicine, Auckland City Hospital Auckland, New Zealand.
authors: Sandra
authors: S
authors: Hotu
authors: Microbiology Department, Middlemore Hospital Auckland, New Zealand.
authors: Susan
authors: S
authors: Taylor
authors: Radiology Department, Middlemore Hospital Auckland, New Zealand.
authors: Graeme
authors: G
authors: Anderson
authors: Medicine Department, Middlemore Hospital Auckland, New Zealand.
authors: Conroy
authors: C
authors: Wong
keywords: Extrinsic allergic alveolitis; Mycobacterium avium-intracellulare; Mycobacterium phocaicum; hot tub lung; hypersensitivity pneumonitis