At bronchoscopy Mycobacterium avium complex (MAC) was isolated and the patient was started on appropriate long term, dual antimicrobial therapy. MAC encompasses two atypical mycobacterial species M. avium and M. intracellulare. MAC is prevalent worldwide with the highest incidence in immunocompromised patients 1. This patient was, however, immunocompetent.
Reich and Johnson (1992) were first to describe Lady Windermere syndrome which refers to the propensity to develop isolated bronchiectasis of the right middle lobe or lingula with subsequent MAC infection of the affected lobe specifically in Caucasian, elderly ladies with habitual voluntary cough suppression as a causative aetiology 2.