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A Case of Hypercalcemia Secondary to Hot Tub LungA Case of Hypercalcemia Secondary to Hot Tub Lung

Jessica Donato, MD; Colin T. Phillips, MD; Adam W. Gaffney, MD; Paul A. VanderLaan, MD, PhD; Majd Mouded, MD
Author and Funding Information

From the Department of Medicine (Drs Donato and Phillips), Department of Pulmonary and Critical Care Medicine (Drs Gaffney and Mouded), and Department of Pathology (Dr VanderLaan), Beth Israel Deaconness Medical Center; and Department of Pulmonary Medicine (Dr Mouded), Harvard Vanguard Medical Associates, Boston, MA.

CORRESPONDENCE TO: Colin T. Phillips MD, Beth Israel Deaconess Medical Center, Department of Medicine, 330 Brookline Ave, Boston, MA 02215; e-mail: ctphilli@bidmc.harvard.edu


Drs Donato and Phillips contributed equally to this work.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;146(6):e186-e189. doi:10.1378/chest.14-0350
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Hypersensitivity pneumonitis (HP) is a diffuse granulomatous lung disease resulting from inhalation of an antigen to which an individual has been previously sensitized. Hot tub lung is an increasingly common form of HP associated with inhalation of water aerosols containing Mycobacterium avium complex organisms that contaminate hot tub water. Granulomatous lung disorders, most classically sarcoidosis, have been associated with unregulated 1-α-hydroxylase expression by macrophages present in the granulomas, causing conversion of 25-OH-vitamin D to the active form of vitamin D, 1,25(OH)2 vitamin D, and, thus, hypercalcemia. To our knowledge, this is the first confirmed case of hypercalcemia secondary to elevated 1,25(OH)2 vitamin D levels associated with HP.

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