Hot tub lung

Last revised by Craig Hacking on 9 Jun 2020

Hot tub lung refers to pulmonary disease in otherwise healthy patients that can occur by secondary exposure to aerosolized non-tuberculous mycobacteria in contaminated hot water-steam (classically described in hot tubs, hence the name). 

It can present as an acute pulmonary illness with fever and dyspnea.

The pathology of hot tub lung is thought to be related to an infection, a hypersensitivity reaction (the latter is more favored) or both. Therefore it is also sometimes classified as a precipitant for hypersensitivity pneumonitis. A granulomatous pneumonitis then tends to occur.

Hypersensitivity pneumonitis-like reaction to mycobacteria can also occur from exposures other than just hot tubs.

Imaging appearances can mimic a subacute hypersensitivity pneumonitis from other causes 1. Described features include 1,5:

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