Diffuse pulmonary disease caused by nontuberculous mycobacteria in immunocompetent people (Hot tub lung)

Andras Khoor, K. O. Leslie, H. D. Tazelaar, R. A. Helmers, T. V. Colby

Research output: Contribution to journalArticle

132 Citations (Scopus)

Abstract

The clinicopathologic spectrum of infections due to nontuberculous mycobacteria (NTM) includes cavitary disease, opportunistic infection, and nodular disease associated with bronchiectasis. We report a less well-described manifestation of NTM infection: 10 immunocompetent patients without preexisting bronchiectasis had radiographic evidence of diffuse infiltrative lung disease. The most common symptoms were dyspnea, cough, hypoxia, and fever. All 10 patients had used a hot tub. Histologic examination revealed exuberant nonnecrotizing, frequently bronchiolocentric, granulomatous inflammation in all cases. In 1 case, necrotizing granulomas were also noted. The inflammation often was associated with patchy chronic interstitial pneumonia and organization. Cultures revealed NTM in all cases (Mycobacterium avium complex in all but 1 case), but staining for acid-fast bacilli was positive in only 1 case. Four patients received corticosteroids alone for presumed hypersensitivity pneumonia, 4 were treated with antimycobacterial therapy, and 2 received both. All patients demonstrated significant improvement at the time of follow-up. These findings suggest that disease due to NTM may manifest as diffuse infiltrates in immunocompetent adults and that hot tub use may be an important risk factor for this disease pattern.

Original languageEnglish (US)
Pages (from-to)755-762
Number of pages8
JournalAmerican Journal of Clinical Pathology
Volume115
Issue number5
DOIs
StatePublished - 2001

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Nontuberculous Mycobacteria
Lung Diseases
Lung
Bronchiectasis
Nontuberculous Mycobacterium Infections
Inflammation
Mycobacterium avium Complex
Interstitial Lung Diseases
Opportunistic Infections
Granuloma
Cough
Dyspnea
Bacillus
Pneumonia
Adrenal Cortex Hormones
Hypersensitivity
Fever
Staining and Labeling
Acids
Infection

Keywords

  • Granulomas
  • Hot tub
  • Lung disease
  • Mycobacterium avium complex
  • Nontuberculous mycobacteria

ASJC Scopus subject areas

  • Pathology and Forensic Medicine

Cite this

Diffuse pulmonary disease caused by nontuberculous mycobacteria in immunocompetent people (Hot tub lung). / Khoor, Andras; Leslie, K. O.; Tazelaar, H. D.; Helmers, R. A.; Colby, T. V.

In: American Journal of Clinical Pathology, Vol. 115, No. 5, 2001, p. 755-762.

Research output: Contribution to journalArticle

Khoor, Andras ; Leslie, K. O. ; Tazelaar, H. D. ; Helmers, R. A. ; Colby, T. V. / Diffuse pulmonary disease caused by nontuberculous mycobacteria in immunocompetent people (Hot tub lung). In: American Journal of Clinical Pathology. 2001 ; Vol. 115, No. 5. pp. 755-762.
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