Wednesday, May 17, 2006

Follow up to Progressive dyspnea

This is the case of the 71 year old with 3 months of dyspnea. AK astutely pointed to the hot tub and indeed, the patient's use of the hot tub in his new home coincided with the onset of symptoms. A transbronchial biopsy during his illness

showed chronic and granulomatous inflammation, with focal active lung injury.
The BAL was negative for mycobacteria (specifically mycobacterium avium complex (MAC)). He was started on prednisone 60 mg and his symptoms are essentially resolved after 1 month of therapy. His followup CXR showed clearing of much of the prior acute interstitial infiltrates:

Final Diagnosis: Hypersensitivity pneumonitis ("Hot tub lung")

3 comments - CLICK HERE to read & add your own!:

Baleeiro said...

Great case. Did he get rid of the hot tub?

Jennings said...

Yes so it's difficult to tell with certainty whether his improvement is due to the steroids or to removal of antigen source. The data on steroid efficacy for HP suggests that steroids are not very effective for chronic HP (even before onset of fibrosis), but that it may be somewhat helpful for the acute phase.
Eur J Resp Dis 1983 64:283
Kokkarinen et al Am Rev Respir Dis 1992 145:3

Anonymous said...

why one has thought of MAC?