Hot Tub Lung: Case Report and Review of the Literature.

INTRODUCTION: Nontuberculous mycobacteria-related hypersensitivity pneumonitits (NTM-HP), otherwise known as hot tub lung, is an uncommon disease produced by exposure to aerosolized hot tub water containing nontuberculous mycobacteria. Patients usually present with nonspecific, prolonged respiratory symptoms and require a thorough respiratory workup, including radiography and even pulmonary biopsies. CASE PRESENTATION: We present the case of a 58-year-old patient with chronic respiratory symptoms and history of exposure to a hot tub. DISCUSSION: There is little data on why certain patients develop NTM-HP; however, it seems to be an immunologic response to the nontuberculous mycobacteria, not a primary infection. The treatment, as in this case, is typically just hot tub avoidance. CONCLUSION: To our knowledge, this is the first case of NTM-HP reported from Wisconsin. NTM-HP can mimic nontuberculous mycobacterial disease and should be on the differential diagnosis for patients with unclear chronic respiratory problems.

Markedly elevated alpha-fetoprotein levels without hepatocellular carcinoma.

Although low-grade elevations of AFP are associated with benign liver disease including acute and chronic hepatitis and cirrhosis, AFP values above 400 ng/mL are often used as a surrogate marker for HCC. The case of a 45-year-old Caucasian woman, who while receiving interferon therapy for HCV, was found to have a marked elevation of her serum AFP level, is reported. Her baseline AFP of 7.0 ng/mL increased progressively over three months to a peak value of 734.5 ng/mL. Initial imaging was normal. Three months later, a CT scan detected two focal lesions in the dome of the liver. A post-ethiodol hepatic CT scan revealed persistent uptake at this site but fluoroscopy-guided liver biopsy failed to identify a HCC. Normalization of her AFP level occurred while she continued to receive IFN for HCV. The patient has remained stable over more than three years of follow-up. While others have reported AFP elevations in cirrhotics with HCV without evidence of HCC, to our knowledge there are no reports of an individual receiving IFN treatment for hepatitis C with AFP levels that rose over several months in the absence of a HCC.