Micobacterium intracellulare in a patient with Lady Windermere syndrome

Abstract

Mycobacterium intracellulare is a non-tuberculous acid-alcohol resistant bacillus, which belongs to the complex Mycobacterium avium. The infection due to M. intracellulare can manifest itself as a fibrocavitary lung disease, as a hypersensitivity pneumonitis, or as a bronchiectasis superinfection, one of which variants is the Lady Windermere syndrome (LWS), affecting slender elderly women, with higher incidence of scoliosis, and with bronchiectasis and/or nodules in the middle lobe or lingula. A case of a 61-year-old female patient is reported –with a diagnosis of COPD, extreme thinness, and scoliosis–, who consults due to a respiratory syndrome of cough with expectoration, general malaise, fever and tiredness. The tomography shows evidence of bronchiectasis and nodules in the middle lobe and lingula. A sputum culture is ordered for mycobacteria and bacilloscopy. The results were ZN ++++ and culture positive. A molecular identification was conducted at the Instituto Malbrán. Isolation showed a 100% identity with the pattern strain of Mycobacterium intracellulare ATCC 13950. Knowing whether a lung disease caused by environmental mycobacteria –such as LWS– exists would allow an earlier diagnosis, avoiding the clinical deterioration of the patient, and a lower charge on the resources of medical attention during long periods of time.