Lady Windermere Syndrome: A Very Rare Entity In Indian Medical Scenario

Right middle lobe (RML) syndrome is defined as recurrent or chronic obstruction or infection of the middle lobe of the right lung. Nonobstructive causes of middle lobe syndrome include inflammatory processes and defects in the bronchial anatomy and collateral ventilation. We report on 2 case patients with RML syndrome, one due to infection with Mycobacterium avium complex followed by M asiaticum infection and the other due to allergic bronchopulmonary aspergillosis. A history of atopy, asthma, or chronic obstructive pulmonary disease has been reported in up to one-half of those with RML. The diagnosis can be made by plain radiography, computed tomography, and bronchoscopy. Medical treatment consists of bronchodilators, mucolytics, and antimicrobials. Patients whose disease is unresponsive to treatment and those with obstructive RML syndrome can be offered surgical treatment.

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“…It has also been associated with the continuous use of antitussive drugs. 22 In all cases, treatment is directed at the underlying etiology.…”

Section: Discussionmentioning

confidence: 99%

Infectious Causes of Right Middle Lobe Syndrome

2017

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“…The standard treatment for MAC infection is macrolides (clarithromycin or azithromycin), rifampicin, and ethambutol combination [ 4 ]. In cases of nonresponse to the abovementioned medical management, surgical interventions with selective pulmonary resection can be considered in a small group of patients [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

“…In the index case report, it was postulated that the specific lung involvement pattern could probably be because of voluntary cough suppression in the described population of patients [ 2 ]. Over the years, other possible associations including thoracic skeletal abnormalities such as pectus excavatum and connective tissue diseases have also been noted in patients diagnosed with LWS [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Lady Windermere Syndrome: A Rare Differential Diagnosis for Hemoptysis

Krishnan,

Janaka,

Fernando

et al. 2024

Cureus

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Mycobacterium avium complex (MAC) is often observed in immunocompromised individuals. However, when pulmonary MAC infection occurs in immunocompetent individuals, particularly elderly females, characteristically involving the middle lobe and lingula lobe of the lung, it is known as Lady Windermere syndrome (LWS). A 64-year-old female patient with no significant comorbidities presented with a history of low-grade intermittent fever and dry cough for one-month duration complicated with hemoptysis for two days. Her initial investigations and imaging were negative, except for the high-resolution CT (HRCT) finding of bronchiectasis involving the middle lobe and lingula lobe suggestive of MAC infection, which was further confirmed by positive sputum culture for MAC. LWS is a condition that is rarely encountered in clinical settings and seldom described in the literature. Especially in resource-limited settings, arriving at a diagnosis is further hindered by the scarce availability of advanced imaging such as HRCT. In clinical settings where pulmonary tuberculosis is endemic, the differentiation of the two conditions is of paramount importance as the treatment regimens for the two conditions are quite different.

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“…This syndrome is associated with right middle lobe or lingular segmental bronchiectasis and often manifests as a chronic cough with or without sputum production. NTMLD can also lead to fibrodular bronchiectasis, characterized by bronchiectasis (abnormal dilation of bronchial tubes) and the formation of nodules within the lungs, resulting in persistent respiratory symptoms [ 29 ].…”

Section: Reviewmentioning

confidence: 99%

Unveiling the Clinical Diversity in Nontuberculous Mycobacteria (NTM) Infections: A Comprehensive Review

Bhanushali,

Jadhav,

Ghewade

et al. 2023

Cureus

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Once considered rare, nontuberculous mycobacterial (NTM) infections have garnered increasing attention in recent years. This comprehensive review provides insights into the epidemiology, clinical diversity, diagnostic methods, treatment strategies, prevention, and emerging research trends in NTM infections. Key findings reveal the global prevalence of NTM infections, their diverse clinical presentations affecting respiratory and extra-pulmonary systems, and the diagnostic challenges addressed by advances in microbiological, radiological, and immunological methods. Treatment complexities, especially drug resistance and patient adherence, are discussed, along with the vulnerability of special populations. The importance of early detection and management is underscored. Prospects in NTM research, including genomics, diagnostics, drug development, and multidisciplinary approaches, promise to enhance our understanding and treatment of these infections. This review encapsulates the multifaceted nature of NTM infections, offering a valuable resource for clinicians, researchers, and public health professionals.

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Lady Windermere Syndrome: A Very Rare Entity In Indian Medical Scenario

Cited by 8 publications

References 13 publications

Infectious Causes of Right Middle Lobe Syndrome

Infectious Causes of Right Middle Lobe Syndrome

Lady Windermere Syndrome: A Rare Differential Diagnosis for Hemoptysis

Unveiling the Clinical Diversity in Nontuberculous Mycobacteria (NTM) Infections: A Comprehensive Review

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