Lady Windermere’s disease

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).



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