SAUNA KULLANIMI SONRASI GELİŞEN AKUT SOLUNUM YETMEZLİĞİ OLGUSU

Sauna kullanımı çeşitli akut ve geçici, kardiyovaskülerve hormonal değişikliklere neden olsa da çoğu sağlıklıerişkin ve çocuk tarafından iyi tolere edilir. Ancak, akutrespiratuvar infeksiyon geçirenlerin sauna kullanmamaları önerilmektedir. Ayrıca, sempatomimetik ilaçlarsaunada taşikardi ve aritmileri provoke edebilir. Sauna kullanımının kontrendikasyonları ise; stabil olmayan anjina pektoris, yakında geçirilen miyokard infarktüsü, ciddi aort stenozu, dekompanze kalp yetmezliğive yaşlılarda görülen ciddi ortostatik hipotansiyondur.Sauna veya jakuzi kullanımına bağlı olarak günümüzedeğin bildirilen olgulardaki en yaygın akciğer patolojileri hipersensitivite pnömonitleridir. Sağlıklı, genç birerişkin olan olgumuz, sauna kullanımı ve özellikle saunada mentol buharı soluma sonrasında bayılmış veardından akut solunum yetmezliği tablosunda acilenhastaneye yatırılmıştır. Başvurusunda çekilen toraksbilgisayarlı tomografisinde her iki akciğer parankiminde simetrik, diffüz, alt loblarda daha belirgin olmaküzere sentrilobüler konsantrasyon ve peribronkovasküler dağılım gösteren buzlu cam opasiteleri görülmüştür. Olguya antibiyotik, antiviral, steroid, mukolitikilaçlar, intravenöz hidrasyon ve oksijen tedavileri uygulanmış ve hasta birkaç gün içinde taburcu edilmiştir.Taburcu olduktan beş gün sonra çekilen kontrol grafisive solunum fonksiyon testleri normal bulunan hasta,bu klinik ve radyolojik bulgulara neden olabilecek hastalıklar literatür eşliğinde tartışılarak sunulmuştur.

A CASE DEVELOPING ACUTE RESPIRATORY INSUFFICIENCY AFTER A SAUNA BATH

Although sauna bath causes various acute and transient, cardiovascular and hormonal changes, it is generally well tolerated by healthy adults and children. However, the sauna takers are recommended not to take a sauna during an acute respiratory infection. Additionally, sympathomimetic drugs may provoke tachycardias and arrythmias during a sauna bath. The contraindications for a sauna bath are unstable angina pectoris, recent myocardial infarction, severe aortic stenosis, decompensated heart failure and severe orthostatic hypotension in the elderly. The most commonly reported cases with a lung pathology due to sauna baths or hot hubs till now, are those cases with some form of hypersensitivity pneumonitis. Our case who was a healthy young adult, developed syncope immediately after a sauna bath, especially inhaling vaporized menthol during the bath and was admitted to a hospital with an acute respiratory insufficiency. A computerized tomography of the patient which was taken upon admission, revealed bilateral, diffuse ground-glass densities showing centrilobular concentration and a bronchovascular distribution. The patient was treated with antibiotics, an antiviral drug, steroids, mucolytics, intravenous hydration and nasal oxygen and was discharged in a few days. The case, of whom a control chest X-ray and pulmonary function tests were found normal five days after the discharge, is reported with a review of literature, especially discussing conditions which may cause similar clinical and radiological findings.

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1. Kauppinen K. Facts and fables about sauna. Ann N Y Acad Sci 1997; 813: 654-62.
2. Metzger WJ, Patterson R, Fink J, Semerdjian R, Roberts M. Sauna-takers disease. Hypersensitivity pneumonitis due to contaminated water in a home sauna. JAMA 1976; 236(19): 2209-11.
3. Rickman OB, Ryu JH, Fidler ME, Kalra S. Hypersensitivity pneumonitis associated with Mycobacterium avium complex and hot tub use. Mayo Clin Proc 2002; 77(11): 1233-7.
4. Cappelluti E, Fraire AE, Schaefer OP. A case of “hot tub lung” due to Mycobacterium avium complex in an immunocompetent host. Arch Intern Med 2003; 163(7): 845-8.
5. Marchetti N, Criner K, Criner GJ. Characterization of functional, radiologic and lung function recovery post-treatment of hot tub lung. A case report and review of the literature. Lung 2004; 182: 271-277.
6. Hanak V, Kalra S, Aksamit TR, Hartman TE, Tazelaar HD, Ryu JH. Hot tub lung: Presenting features and clinical course of 21 patients. Respir Med 2006; 100: 610–615.
7. Huang WC, Lu YH, Lin ZG, Su WL. Sauna lung: hypersensitivity pneumonitis due to Exophiala jeanselmei. Respirology 2010; 15(3): 573-6.
8. Sohar E, Shoenfeld Y, Shapiro Y, Ohry A, Cabili S. Effects of exposure to Finnish sauna. Isr J Med Sci 1976; 12(11): 1275- 82.
9. Hannuksela ML, Ellahham S. Benefits and risks of sauna bathing. Am J Med 2001; 110(2): 118-26.
10. Laitinen LA, Lindqvist A, Heino M. Lungs and ventilation in sauna. Ann Clin Res 1988; 20(4): 244-8.
11. Kunutsor SK, Laukkanen T, Laukkanen JA. Sauna bathing reduces the risk of respiratory diseases: a long-term prospective cohort study. Eur J Epidemiol 2017; 32(12): 1107-1111.
12. Cabri AE, King A, Morrow L, Malesker MA. Pharmacists can help prevent lipoid pneumonia: Two case reports. J Am Pharm Assoc 2017; 57(5): 616-618.
13. Lu M, Yan W, Zhu X, Zhu H. [Exogenous lipoid pneumonia induced by long-term usage of compound menthol nasal drops: a case report]. Beijing Da Xue Xue Bao Yi Xue Ban 2019; 51(2): 359-361.
14. Embil J, Warren P, Yakrus M, Stark R, Corne S, Forrest D, et al. Pulmonary illness associated with exposure to Mycobacterium-avium complex in hot tub water. Hypersensitivity pneumonitis or infection? Chest 1997; 111(3): 813-6.
15. Hirschmann JV, Pipavath SN, Godwin JD. Hypersensitivity pneumonitis: a historical, clinical, and radiologic review. Radiographics 2009; 29(7): 1921-38.
16. Silva CIS, Churg A, Müller NL. Hypersensitivity pneumonitis: spectrum of high-resolution CT and pathologic findings. AJR 2007; 188: 334-344.
17. Gökırmak M, Avcı H, Kalkan Ş, Yıldırım Z. Tatlı su aspirasyonuna bağlı olarak gelişen bir ARDS olgusu. Yoğun Bakım Dergisi 2006; 6(1): 52-57.
18. Estella AA, Bello Fontaiña LP. Sea drowning: a case report and review of the literature. Monaldi Arch Chest Dis 2011; 75(2): 135-7.
19. Sonoo T, Ohshima K, Kobayashi H, Asada T, Hiruma T, Doi K, et al. Acute respiratory distress syndrome (ARDS) treated successfully by veno-venous extracorporeal membrane oxygenation (ECMO) in a nearly drowned patient. J Artif Organs 2014;17(3): 281-4.
20. Szpilman D, Bierens JJ, Handley AJ, Orlowski JP. Drowning. N Engl J Med 2012; 366(22): 2102-10.
21. Mammas IN, Thiagarajan P. Water aspiration syndrome at birth – report of two cases. J Matern Fetal Neonatal Med 2009; 22(4): 365-7.
22. Sotiridou E, Mukhopadhyay S, Clarke P. Neonatal aspiration syndrome complicating a water birth. J Obstet Gynaecol 2010; 30(6): 631-3.