Hypersensitivity pneumonitis reaction to Mycobacterium avium in household water
Hypersensitivity pneumonitis reaction to Mycobacterium avium in household water
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DOI：
10.1378/chest.127.2.664
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发表时间：
2005-02-01
期刊：
影响因子：
9.6
通讯作者：
Daley, CL
中科院分区：
文献类型：
--
作者：
Marras, TK;Wallace, RJ;Daley, CL
背景资料：过敏性肺炎已被描述为暴露于雾化的鸟分枝杆菌复合体（MAC）在室内热水浴缸（热水浴缸肺）。Objectives：描述一个MAC相关的过敏性肺炎样反应的情况下，可能从淋浴和审查以前的热水浴缸肺reports.Methods：对于该病例报告，我们调查了一名患者的组织学诊断过敏性肺炎和MAC阳性痰培养结果。从他的家中和工作场所获得分枝杆菌培养物。使用脉冲场凝胶电泳对分离株进行分型。为了进行综述，检索了MEDLINE和EMBASE中的热浴盆肺报告，并对其进行了综述和总结。结果：一位50岁男性有进行性呼吸困难、阵发性发热和肌痛。肺功能检查结果显示阻塞和弥散受损;胸部CT扫描发现弥漫性小叶中心磨玻璃结节和空气潴留，以及淋巴细胞性肺泡炎伴CD 4/CD 8比值升高。经支气管活检显示多发性良性非坏死性肉芽肿。多个呼吸道样本和淋浴和浴缸标本增长MAC，与匹配的脉冲场凝胶电泳模式。患者从淋浴改为浴缸浴。泼尼松和抗分枝杆菌药物给药约1年。他的症状、肺功能异常和CT扫描结果消退。文献回顾共收集到36例热水浴缸肺。临床特征包括呼吸困难（97%）、咳嗽（78%）和发热（58%）。肺功能检查显示阻塞（67%）、限制（55%）和弥散受损（75%）。胸部CT扫描显示磨玻璃影（95%）和结节（67%）。95%的肉芽肿形态良好。治疗包括停止使用热水浴缸和强的松，抗分枝杆菌药物，或两者兼而有之。结果是有利的。结论：过敏性肺炎样反应分枝杆菌可以发生暴露以外的热水浴缸。经典过敏性肺炎和MAC相关过敏性肺炎之间存在关键差异。可能需要抗分枝杆菌治疗。淋浴导致MAC过敏性肺炎的可能性在过敏性肺炎患者的调查中提出了潜在的意义。
Background: Hypersensitivity pneumonitis has been described with exposure to aerosolized Mycobacterium avium complex (MAC) in indoor hot tubs (hot tub lung).Objectives: To describe a case of MAC-associated hypersensitivity pneumonitis-like reaction possibly from showering and review previous hot tub lung reports.Methods: For the case report, we investigated a patient with histologically diagnosed hypersensitivity pneumonitis and MAC-positive sputum culture findings. Mycobacterial cultures were obtained from his home and workplace. Isolates were typed using pulsed-field gel electrophoresis. For the review, MEDLINE and EMBASE were searched for hot tub lung reports, which were reviewed and summarized. Results: A 50-year-old man had progressive dyspnea and episodic fever and myalgias. Pulmonary function testing results revealed obstruction and impaired diffusion; a chest CT scan found diffuse, centrilobular, ground-glass nodules, and air trapping, and a lymphocytic alveolitis with an elevated CD4/CD8 ratio. Transbronchial biopsy showed multiple well-formed nonnecrotizing granulomas. Multiple respiratory samples and shower and bathtub specimens grew MAC, with matching pulsed-field gel electrophoresis patterns. The patient changed from showering to tub bathing. Prednisone and antimycobacterial drugs were administered for approximately I year. His symptoms, pulmonary function abnormalities, and CT scan findings resolved. The literature review yielded 36 cases of hot tub lung. Clinical features included dyspnea (97%), cough (78%), and fever (58%). Pulmonary function testing showed obstruction (67%), restriction (55%), and impaired diffusion (75%). A chest CT scan showed ground-glass opaciftcation (95%) and nodules (67%). Granulomas were well-formed in 95%. Treatments included discontinuation of hot tub use and prednisone, antimycobacterial drugs, or both. Outcomes were favorable.Conclusions: A hypersensitivity pneumonitis-like reaction to mycobacteria can occur from exposures other than hot tubs. There are key differences between classic hypersensitivity pneumonitis and MAC-associated hypersensitivity pneumonitis. Antimycobacterial therapy may be required. The possibility of MAC hypersensitivity pneumonitis from showering raises potential implications in the investigation of patients with hypersensitivity pneumonitis.