Lady Windermere syndrome

Case contributed by Dr Sophie O'Dowd

Presentation

History of asthma with recent poor control, lingering cough for 6 weeks, haemoptysis, Caucasian non-smoker.

Patient Data

Age: 66
Gender: Female
X-ray

PA chest radiograph demonstrates a sharp edge abnormality in the region of the right hilum.

Lateral chest radiograph demonstrates a band-like increased opacity in the region of the right middle lobe.

CT

The CT demonstrates complete collapse of the right middle lobe with independent occlusion of both the medial and lateral bronchi making a central obstructive lesion unlikely.

Case Discussion

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

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Case information

rID: 41070
Case created: 14th Nov 2015
Last edited: 5th Nov 2017
System: Chest
Inclusion in quiz mode: Included

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