Lady Windermere syndrome with haemoptysis: suspected pulmonary aspergilloma and MAC pulmonary disease

Abstract

We present a case of a woman in her 70s, with a history ofMycobacterium aviumcomplex (MAC) pulmonary disease, pectus excavatum, s-shaped thoracolumbar scoliosis, bronchiectasis of the right middle lobe, lingula of left upper lobe, and malnutrition with low body mass index of 14 kg/m2, who presented to the hospital due to worsening shortness of breath and small volume haemoptysis over 2 weeks. The patient was diagnosed with pulmonary MAC infection for the first time in 1999 without known history of pulmonary disease. Later on, it was complicated by massive haemoptysis requiring bronchial artery embolisation; however, she was unable to complete an oral antibiotic regimen due to gastrointestinal adverse reactions. Chest CT identified a newly found mass in the left upper lobe bulla, consistent with a radiological finding of aspergilloma. We present a rare symptoms constellation, described as ‘Lady Windermere syndrome’ and chronic untreated MAC infection progressing from reticulonodular changes to fibrocavitary lung disease and suspected aspergilloma formation.

A Case of Rapidly Diagnosed Mycobacterium intracellulare in a Frail Geriatric Patient With Multimorbidity

“…This case somewhat mimics Lady Windermere syndrome, where elderly women with low BMI have MAC pulmonary infections localized to the right middle lobe due to inadequate drainage of lung secretions [11]. Therefore, postural drainage and acetylcysteine aerosol inhalation were used to ensure smooth sputum drainage.…”