[Cutaneous lesions during hot-tub hypersensitivity pneumonitis: Pseudomonas folliculitis ?]
BACKGROUND
Interstitial lung disease, cutaneous rash and elevated serum angiotensin converting enzyme (ACE) may suggest diagnoses other than sarcoidosis.


METHODS
A 58-year-old man had presented dyspnoea for 2 years with increased angiotensin-converting enzyme, as well as an interstitial syndrome and micronodules. The possibility of sarcoidosis was raised. Systemic corticosteroids resulted in improvement of the dyspnoea although it recurred on dose reduction. We noted fluctuating eczematous macules of the limbs with a histology of aspecific folliculitis. The identification of Mycobacterium avium complex (MAC) in the bronchoalveolar wash prompted us to initiate antimycobacterial therapy, but this was to no avail. Review of the CT-scan and questioning of the patient (daily use of a Jacuzzi for 7 years) resulted in diagnosis of hypersensitivity pneumonitis due to MAC. The cutaneous lesions were taken to indicate "hot tub folliculitis". Discontinuation of hot-tub use and a short course of oral corticosteroids resulted in healing within 4 months, with no recurrence at 2 years.


CONCLUSIONS
HTL is a form of hypersensitivity pneumonitis due to the presence of MAC in the water of Jacuzzis. This condition regresses spontaneously without treatment on discontinuation of Jacuzzi use. Hot-tub folliculitis due to Pseudomonas aeruginosa (PA) presents as macules and papules on covered skin areas (swimsuit) within 48hours of bathing and often declines within 2 weeks.


CONCLUSIONS
Our case is original as regards the concomitant lung and cutaneous involvement associated with Jacuzzi use, with an immunoallergic mechanism for the MAC and probably an infectious mechanism for the PA.
Service de dermatologie, hôpital Saint-André, CHU de Bordeaux, rue Jean-Burguet, 33076 Bordeaux, France.
N
N
Sokolowsky
Service de médecine interne et maladies infectieuses, hôpital Saint-André, CHU de Bordeaux, rue Jean-Burguet, 33076 Bordeaux, France.
L
L
Rolland
Service de médecine interne et maladies infectieuses, hôpital Saint-André, CHU de Bordeaux, rue Jean-Burguet, 33076 Bordeaux, France.
M-A
MA
Vandenhende
Service de médecine interne, centre hospitalier, 20, avenue de Saint-Sordelin Plage, 17640 Vaux-sur-Mer, France.
J-Y
JY
Colin
Service d'imagerie médicale - radiologie diagnostique et thérapeutique, hôpital Haut-Lévêque, CHU de Bordeaux, avenue de Magellan, 33600 Pessac, France.
F
F
Laurent
Service de médecine interne et maladies infectieuses, hôpital Saint-André, CHU de Bordeaux, rue Jean-Burguet, 33076 Bordeaux, France.
P
P
Morlat
Service de médecine interne et maladies infectieuses, hôpital Saint-André, CHU de Bordeaux, rue Jean-Burguet, 33076 Bordeaux, France.
F
F
Bonnet
Service de dermatologie, hôpital Saint-André, CHU de Bordeaux, rue Jean-Burguet, 33076 Bordeaux, France. Electronic address: marie.beylot-barry@chu-bordeaux.fr.
M
M
Beylot-Barry
D000542:Alveolitis, Extrinsic Allergic / Q000209:etiology* / Q000382:microbiology; D001494:Baths / Q000009:adverse effects*; D003937:Diagnosis, Differential; D004417:Dyspnea / Q000209:etiology; D005499:Folliculitis / Q000209:etiology* / Q000382:microbiology; D006358:Hot Temperature; D006801:Humans; D008297:Male; D008875:Middle Aged; D015269:Mycobacterium avium Complex / Q000302:isolation & purification*; D015270:Mycobacterium avium-intracellulare Infection / Q000209:etiology*; D011549:Pseudomonas / Q000302:isolation & purification*; D011552:Pseudomonas Infections / Q000209:etiology*; D017565:Sarcoidosis, Pulmonary / Q000175:diagnosis; D014871:Water Microbiology
Folliculite; Hot-tub folliculitis; Hot-tub lung; Jacuzzi; Pneumopathie d’hypersensibilité; Pseudomonas