B71-11 Hot Tub Pneumonia

Introduction Hot tub associated pneumonia is an uncommon respiratory infection caused by inhalation of aerosolized pathogens from hot tubs. Legionella species, nontuberculous mycobacteria (NTM), and Pseudomonas aeruginosa are among the most frequently implicated organisms. Such infections can mimic or exacerbate underlying respiratory conditions, particularly asthma, and are often underdiagnosed due to nonspecific clinical and radiologic findings. We present a case of hot tub associated pneumonia. Case Presentation A 64-year-old male with a history of asthma presented with a five-day history of progressive shortness of breath, cough, and wheezing, requiring 4 L/min of supplemental oxygen via nasal cannula. The patient reported multiple recurrent hospitalizations and emergency department (ED) visits over the past six months for episodes of pneumonia necessitating antibiotic therapy. He had been evaluated in the ED two days prior for similar symptoms. At that time, a chest radiograph was unremarkable; however, a computed tomography (CT) scan of the chest demonstrated mild patchy airspace opacities with bilateral lower lobe bronchitis. He was discharged home on oral amoxicillin-clavulanate (875 mg twice daily), but his symptoms persisted and progressively worsened, with increased cough, wheezing, and dyspnea. On examination, expiratory wheezes were appreciated bilaterally. Further history revealed that the onset of symptoms coincided with the recent installation of a heated pool at his residence, which he used frequently. Given this temporal association, the clinical presentation raised suspicion for hot tub-associated pneumonia. Differential diagnoses included Legionella species, nontuberculous mycobacteria (NTM), and Pseudomonas aeruginosa, with possible exacerbation of his underlying asthma. The patient was treated with oral levofloxacin 750 mg daily for seven days and oral prednisone 40 mg daily for five days. His symptoms improved rapidly, with resolution of wheezing and cough. Supplemental oxygen was successfully discontinued, and the patient was discharged home in stable condition with no further reports of recurrent hospitalizations and ED visits. Discussion Legionella species and NTM are the primary pathogens to consider in cases of pneumonia following hot tub exposure, with Pseudomonas aeruginosa representing a less common but plausible etiology. Accurate diagnosis often necessitates a high index of suspicion, particularly in patients presenting with recurrent or persistent respiratory symptoms after such environmental exposure. This case highlights the critical role of obtaining a detailed environmental exposure history in individuals with recurrent respiratory infections and illustrates how hot tub-associated pneumonia may exacerbate underlying asthma. Prompt recognition and appropriate management are essential to achieve rapid clinical improvement and to prevent subsequent exacerbations. This abstract is funded by: None