|Fever - Pyrexia of unknown origin
|Lady Windermere syndrome
Bronchiectasis in the middle lobe
and lingula is highly suggestive of MAC disease
- Named after a character in Oscar Wilde's play Lady Windermere's Fan.
- Reich and Johnson hypothesized that cough suppression in “polite” women was the
mechanism of disease, there are no large studies which support this idea
- Mycobacterium avium complex (MAC)
- Non-tuberculous mycobacterial infection
- Usually seen typically in white women age 60 and over who chronically suppress the normal cough reflex.
- May have scoliosis or pectus excavatum, low-normal BMI and a slender body habitus
with decreased subcutaneous fat
- Fastidious nature and a reticence to expectorate are believed to predispose such persons to infections with MAC.
It is one of the causes of right middle lobe syndrome
- Chest X-ray is often normal: The middle lobe is most frequently
- CT chest: bronchiectasis, centrilobular nodules and eventual scarring and volume loss affecting the middle lobe and lingula. Typically, These women had no hilar adenopathy or cavitary
- The diagnosis is often difficult because the organism is not readily isolated or cultured, and the condition may not be considered by the radiologist.
- Standard Antituberculous treatment. These patients usually respond well to clarithromycin-based multi drug regimens, but surgery is sometimes required to resect the infected regions of the lung