Lady Windermere’s disease
- MAC infection in old women who chronically suppress the cough reflex.
- Reticence to expectorate are believed to predispose such persons to infections with MAC
- main cause of right middle lobe syndrome (chronic right middle lobe atelectasis without obstruction)
- Clue: #1
– RML (or lingula) atelectasis without obstruction
– bronchiectasia and centrilobular nodules (infectious bronchiolitis)
Mnemonic ABC: Atelectasis of RML (& lingula), bronchiectasis, centrilobular nodules
- Treatment: combination of drugs for 12 months
– Commonly used first-line drugs include macrolides (clarithromycin or azithromycin), ethambutol, and rifamycins (rifampin, rifabutin).