{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2023,5,18]],"date-time":"2023-05-18T10:11:01Z","timestamp":1684404661385},"reference-count":6,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2008,5,13]],"date-time":"2008-05-13T00:00:00Z","timestamp":1210636800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/www.springer.com\/tdm"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Med Case Reports"],"published-print":{"date-parts":[[2008,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p><jats:italic>Mycobacterium avium<\/jats:italic>complex (MAC) is an increasingly recognized cause of pulmonary disease in immunocompetent individuals. An acute form of MAC lung disease, MAC-associated pneumonitis, has generally been associated with the use of hot tubs. There is controversy in the literature about whether MAC-associated pneumonitis is a classic hypersensitivity pneumonitis or is a direct manifestation of mycobacterial infection.<\/jats:p><\/jats:sec><jats:sec><jats:title>Case presentation<\/jats:title><jats:p>We report the second case in the literature of MAC-associated pneumonitis not related to the use of hot tubs. The source of MAC in a 52-year-old immunocompetent patient was an intrapulmonary cyst containing numerous acid-fast bacilli. The patient developed disseminated miliary nodules throughout both lung fields. Histological examination of resected lung tissue revealed well-formed, acid-fast negative granulomas composed predominantly of CD4<jats:sup>+<\/jats:sup>T-cells and CD68<jats:sup>+<\/jats:sup>histiocytes. The granulomas were strongly positive for tumor necrosis factor-\u03b1, a pro-inflammatory cytokine.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The attempt to classify MAC-associated pneumonitis as either a classic hypersensitivity pneumonitis or a direct manifestation of mycobacterial infection is not particularly useful. Our case demonstrates that MAC-associated pneumonitis is characterized by a vigorous T-helper 1-like, pro-inflammatory, immune response to pulmonary mycobacterial infection. The immunopathology provides a rationale for clinical studies of anti-MAC therapy with the addition of anti-inflammatory agents (for example, corticosteroids) to hasten the resolution of infection and symptoms.<\/jats:p><\/jats:sec>","DOI":"10.1186\/1752-1947-2-152","type":"journal-article","created":{"date-parts":[[2008,5,13]],"date-time":"2008-05-13T18:14:01Z","timestamp":1210702441000},"update-policy":"http:\/\/dx.doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Lessons from Mycobacterium avium complex-associated pneumonitis: a case report"],"prefix":"10.1186","volume":"2","author":[{"given":"Victor","family":"Zota","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sheryn M","family":"Angelis","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Armando E","family":"Fraire","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ciaran","family":"McNamee","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shasta","family":"Kielbasa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel H","family":"Libraty","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2008,5,13]]},"reference":[{"key":"339_CR1","volume-title":"Respir Med","author":"V Hanak","year":"2005","unstructured":"Hanak V, Kalra S, Aksamit TR, Hartman TE, Tazelaar HD, Ryu JH: Hot tub lung: Presenting features and clinical course of 21 patients. 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J Allergy Clin Immunol. 2001, 108 (5): 661-670. 10.1067\/mai.2001.119570.","journal-title":"J Allergy Clin Immunol"},{"issue":"4","key":"339_CR6","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1183\/09031936.93.06040477","volume":"6","author":"N Satake","year":"1993","unstructured":"Satake N, Nagai S, Kawatani A, Kaneshima H, Tanaka S, Takeuchi M, Izumi T: Density of phenotypic markers on BAL T-lymphocytes in hypersensitivity pneumonitis, pulmonary sarcoidosis and bronchiolitis obliterans with organizing pneumonia. 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