A 59-year-old man developed pneumonia 9 days after bathing in a hot spring spa. Bilateral shadows on his chest radiograph rapidly progressed after admission. He was successfully treated with erythromycin and rifampicin. Legionella pneumophila serogroup 6 was recovered from an intratrachial specimenand a significant elevation was observed in a paired indirect fluorescent antibody to Legionella. Persistent slight fever and chest rentogenographic shadows resolved after administering low-dose

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... solone to treat organizing pneumoniashownby transbronchial lung biopsy. The same serotype of Legionella was recovered from the water of the hot spring spa where the man had bathed. Whenthe extracted DNAof these two strains showed identical restriction fragments by pulsedfield gel electrophoresis, we had direct evidence that hot spring spas can be a source ofLegionella pneumonia.