Correct!
4. 1 and 3
“Hot tub lung” was first described in 1997 in 5 healthy subjects who developed bronchitis, fever and flu-like symptoms with radiologic features of hypersensitivity pneumonitis after using hot tubs (1). Cultures of sputum, BAL and lung biopsy specimens obtained in several patients were positive for MAC, but all patients improved with cessation of hot tub use. Subsequent reports indicate hot tub lung may present either with features of acute, subacute or chronic hypersensitivity pneumonitis (2). Although lung cultures are often positive for MAC, this is not thought to represent an infection, but rather a hypersensitivity reaction in the lung to the organism. Typical radiologic features include areas of ground-glass attenuation, centrilobular nodules and air trapping on expiratory images (3).
In mild cases of hot tub lung, cessation of hot tub use may be adequate (1,2). If there are more severe symptoms, treatment is similar to that of subacute hypersensitivity pneumonitis with corticosteroid therapy. Although some patients with hot tub lung have also been treated with drug therapy for MAC, it is not thought that his is generally necessary unless there are other indications of infection. Omalizumab is a monoclonal antibody used for treatment of asthma with high IgE levels.
In our patient the culture of lung biopsy was positive for MAC. The patient was told she should no longer use her hot tub which she had been doing more regularly due to increased back pain. Corticosteroid therapy, initially at 40 mg daily then gradually tapered. She noted improvement in symptoms with reduced cough and less shortness of breath. Â Subsequent lung function studies improved with FVC increasing to 68% pred)and Dlco increasing to 70% pred and she was no longer required supplemental oxygen
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