Document Type


Publication Date


Published In / Presented At

American Medical Women’s Association Annual Meeting


Family Medicine | Infectious Disease | Internal Medicine


Hypersensitivity pneumonitis is a unique form of interstitial lung disease that is diverse in its presentation and etiology. • Hypersensitivity pneumonitis is mediated by an inflammatory reaction to inhalation of an environmental antigen. It is described as a mixed III/IV hypersensitivity reaction that is characterized by lymphocyte predominance and high CD4:CD8 ratio. • Hot tub lung is one etiology of hypersensitivity pneumonitis which can occur from exposure to mycobacterium antigens in water-related contamination, most notably hot tubs. • It most commonly presents with patients who have underlying lung disease or are immunocompromised. However, there has recently been an increase in hot tub lung in otherwise healthy individuals.

58-year old African American female with a history of hypertension and stage 3 breast cancer status post 3 cycles of cyclophosphamide/docetaxel presented to the Emergency Department (ED) with persistent dyspnea, dry cough, and fever. She was discharged earlier that day with a diagnosis of dyspnea with suspicion of pneumonitis after 2 day admission and extensive work-up. Upon discharge, she reported worsening dyspnea with exertion, dry cough, and fever, and returned.

While the patient’s vague symptoms of dyspnea and fever did not point to a specific diagnosis, the additional history revealed possible exposure to mycobacterium antigen through “hot tub like” contamination. • Repeating the history to dig deeper into the patient's daily activities revealed an essential piece of information that led to the diagnosis. • This case is one of the first cases to document hot tub lung in a bathtub.