Pulmonary mycobacterium avium complex infection

Case contributed by Domenico Nicoletti
Diagnosis almost certain


Female patient, elderly, with kyphosis, low-grade fever, fatigue, persistent cough, and purulent sputum

Patient Data

Age: 75 years
Gender: Female

Bilateral mid and lower zone interstitial opacities associated with dilated, thick walled bronchi. 

Varicoid and cylindrical bronchiectasis is present in the middle lobe and lingula, in part atelectatic.

Centrilobular opacity type "tree in bud" are visible in both lower lobes.

There is associated dilation of the main pulmonary artery and its branches, suggestive of pulmonary hypertension.

Case Discussion

Bronchial alveolar lavage was positive for Mycobacterium avium complex (MAC).

In Lady Windermere syndrome, the patient type is typically an elderly female with structural abnormalities of the rib cage.

Symptoms are a productive cough; fever and hemoptysis appear only in case of diffuse pulmonary impairment.

They are usually women who tend to suppress coughs with a consequent stagnation of secretions.

Sputum or bronchial alveolar lavage frequently are positive for MAC on microscopic examination.

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