Hypersensitivity pneumonitis caused by Cladosporium in an enclosed hot-tub

Spirometry from a 48-year-old woman with an 18-month history of malaise and chronic cough, intermittent episodes of fever, chills, and pneumonic infiltrates. Removal of the patient from the home environment led to a resolution of symptoms within one week. Within four hours of reexposure to the hot-tub room, symptoms and signs and changes in leukocyte count and spirometric values again occurred. Bronchial provocation with a commercial extract of C. cladosporioides led to a similar pattern five hours after the initial challenge.