Conclusions "Low-risk" branch duct IPMN may be a heterogeneous disease in which some cases can transform into malignant pancreatic neoplasms despite the absence of the so-called "high risk" features on imaging studies. To avoid the sternal We present a patient with Lady Windermere syndrome after coronary bypass operation. a. complex” or MAC), which are present in soil and water. In general, when pulmonary abnormalities are identified that are consistent with a granulomatous infection, pulmonary MAC needs to be considered along with tuberculosis and fungal infection. The distinctive elements of the Lady Windermere syndrome suggest the hypothesis that habitual voluntary suppression of expectoration ("Ladies do not spit.") 3. Together they form a unique fingerprint. Plain radiographs are frequently normal despite active pulmonary infection. Because of multiple comorbidities, the patient chose chemotherapy over a pancreaticoduodenectomy. The infection may (rarely) appear in elderly ladies with no pre-existing lung disease who chronically suppress the cough reflex and therefore allow respiratory secretions to stagnate. As such, the radiographic appearance is highly variable. The combination of bronchiectasis involving exclusively, or primarily, the right middle lobe and lingula is highly suggestive of pulmonary MAC, even in the face of negative sputum cultures. Pleural effusions and adenopathy are uncommon. Burioni Ricerche Bibliografiche". While at our institution, she was also diagnosed with Lady Windermere syndrome. Widespread disease is common, as is cavitation. Widespread disease is common, as is cavitation. The classic radiographic appearance is indistinguishable from that of pulmonary tuberculosis. AB - Context "Low-risk" branch duct intraductal papillary mucinous neoplasm (IPMN) is defined as pancreatic epithelial cellular proliferation of small branch ducts that lack malignant characteristics. The Lady Windermere syndrome is a special form of pulmonary MAC seen primarily in middle-aged and elderly women. Regardless of the clinical situation, pulmonary MAC infection is often omitted from the radiographic differential even when the appearance is characteristic. Diffuse pulmonary opacities and adenopathy are common features. Mycobacterium szulgai. Pulmonary infection with MAC in the immunocompromised patient generally reflects a widespread systemic disease. AB - Although the radiographic appearance of pulmonary MAC infection in the immunocompetent host can be varied, there are several generalizations that can be made. Case report A 79-year-old woman was referred to our institution because of pancreatic cystic abnormalities and elevated carbohydrate antigen 19-9 (CA 19-9). UR - http://www.scopus.com/inward/record.url?scp=0036737889&partnerID=8YFLogxK, UR - http://www.scopus.com/inward/citedby.url?scp=0036737889&partnerID=8YFLogxK, Powered by Pure, Scopus & Elsevier Fingerprint Engine™ © 2020 Elsevier B.V, "We use cookies to help provide and enhance our service and tailor content. Lady Windermere syndrome is a disorder seen in non-smoking women with no pre-existing pulmonary disease affecting the lingula and/or right middle lobe with Mycobacterium avium-intracellulare complex. / Nguyen, Vien X.; Decker, G. Anton; Das, Ananya; Harrison, M. Edwyn; Silva, Alvin C.; Ocal, Idris T.; Collins, Joseph M.; Nguyen, Cuong C. T1 - The natural history of a branch duct intraductal papillary mucinous neoplasm in a patient with lady windermere syndrome. Clinical management, therefore, requires individualized flexibility. Widespread disease is common, as is cavitation. The hypothesis is that cough suppression in this patient population leads to the development of a non-specific inflammatory process in poorly draining lung regions, which predisposes the host to MAI infection. Pleural effusions and adenopathy are uncommon. The radiographic appearance may be suggestive of the diagnosis of pulmonary MAC, but correlation with the clinical and microbiological data is necessary to confirm the diagnosis. She developed respiratory failure and died after one cycle of gemcitabine. Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic Lady Windermere syndrome: Mycobacterium of sophistication 75-year-old woman was referred to our pulmoA nary clinic with a 4-year history of intermittent episodes of persistent cough, occasionally productive of sputum, and mild exertional dyspnea. Lady Windermere syndrome describes infection in the lungs due to Mycobacterium avium complex. Lady Windermere syndrome: Mycobacterium of sophistication Christopher Donatelli , Atul C. Mehta Cleveland Clinic Journal of Medicine Oct 2015, 82 (10) 641-643; DOI: 10.3949/ccjm.82a.14100 The radiographic findings are bronchiectasis and small nodules, predominately located within the middle lobe and lingula. Especially with pulmonary MAC, radiographic stability over several years does not exclude active disease. NTM pulmonary disease occurring in patients without preexisting lung disease was only recently described by Prince in 1988. The classic radiographic appearance is indistinguishable from that of pulmonary tuberculosis. (2) We observed a case of Lady Windermere syndrome in an elderly woman with no pre-existing lung disease which fit the description given in previous literature. Plain radiographs are frequently normal despite active pulmonary infection. Most patients have upper lobe disease with associated pleural thickening. Pleural effusions and adenopathy are uncommon. We present a case with pancreatic adenocarcinoma after a six-year surveillance of "low-risk" branch duct IPMN in an asymptomatic elderly white woman with Lady Windermere syndrome. Most patients have upper lobe disease with associated pleural thickening. Conclusions "Low-risk" branch duct IPMN may be a heterogeneous disease in which some cases can transform into malignant pancreatic neoplasms despite the absence of the so-called "high risk" features on imaging studies. The combination of bronchiectasis involving exclusively, or primarily, the right middle lobe and lingula is highly suggestive of pulmonary MAC, even in the face of negative sputum cultures. The radiographic findings are bronchiectasis and small nodules, predominately located within the middle lobe and lingula. Especially with pulmonary MAC, radiographic stability over several years does not exclude active disease. Lady Windermere syndrome is a lung infection which shows a pattern named MAC (mycobacterium avium complex). It is named after a character in Oscar Wilde 's 1892 play Lady Windermere's Fan. and Decker, {G. Anton} and Ananya Das and Harrison, {M. Edwyn} and Silva, {Alvin C.} and Ocal, {Idris T.} and Collins, {Joseph M.} and Nguyen, {Cuong C.}". Case report A 79-year-old woman was referred to our institution because of pancreatic cystic abnormalities and elevated carbohydrate antigen 19-9 (CA 19-9). Multiple abdominal imaging studies, endoscopic retrograde cholangiopancreatography, computer tomography, and magnetic resonance cholangiopancreatography (MRCP) were performed in the ensuing 6 years, all consistent with "low-risk" branch duct IPMN. The radiographic appearance may be suggestive of the diagnosis of pulmonary MAC, but correlation with the clinical and microbiological data is necessary to confirm the diagnosis. The story concerns Lady Windermere, who suspects that her husband is having an affair with another woman. Regardless of the clinical situation, pulmonary MAC infection is often omitted from the radiographic differential even when the appearance is characteristic. The Lady Windermere syndrome is a special form of pulmonary MAC seen primarily in middle-aged and elderly women. Classification. As such, the radiographic appearance is highly variable. Radiology of pulmonary Mycobacterium avium-intracellulare complex. Case report A 79-year-old woman was referred to our institution because of pancreatic cystic abnormalities and elevated carbohydrate antigen 19-9 (CA 19-9). 2000 Mar. Pleural effusions and adenopathy are uncommon. Dhillon SS, Watanakunakorn C: Lady Windermere syndrome: middle lobe bronchiectasis and Mycobacterium avium complex infection due to voluntary cough … If you google NON-TUBERCULOUS MYCOBACTERIUM AVIUM COMPLEX PULMONARY DISEASE (MAC/MAI) you will learn … Lady Windermere syndrome is a type of mycobacterial lung infection.. Signs and symptoms FREE book offer – Mayo Clinic Health Letter; The Mayo Clinic Diabetes Diet; Mayo Clinic on Digestive Health; NEW – Mayo Clinic Guide to Arthritis; The Mayo Clinic Diet Online. While at our institution, she was also diagnosed with Lady Windermere syndrome. Multiple abdominal imaging studies, endoscopic retrograde cholangiopancreatography, computer tomography, and magnetic resonance cholangiopancreatography (MRCP) were performed in the ensuing 6 years, all consistent with "low-risk" branch duct IPMN. Because of multiple comorbidities, the patient chose chemotherapy over a pancreaticoduodenectomy. In addition, when there is coexistence of Lady Windermere syndrome and pancreatic cancer, prompt diagnosis and treatment of Lady Windermere syndrome should be considered prior to chemoradiotherapy or surgery. abstract = "Although the radiographic appearance of pulmonary MAC infection in the immunocompetent host can be varied, there are several generalizations that can be made. Mucinous Neoplasm in a Patient with Lady Windermere Syndrome: A Case Report Vien X Nguyen1, G Anton Decker1, ... Mayo Clinic. The radiographic appearance may be suggestive of the diagnosis of pulmonary MAC, but correlation with the clinical and microbiological data is necessary to confirm the diagnosis.". In addition, when there is coexistence of Lady Windermere syndrome and pancreatic cancer, prompt diagnosis and treatment of Lady Windermere syndrome should be considered prior to chemoradiotherapy or surgery. PDF | On May 1, 2016, David H. Ballard and others published Lady Windermere Syndrome | Find, read and cite all the research you need on ResearchGate Here, MAC becomes established, and tussive suppression is overcome. keywords = "And serous, Atypical, Bronchiectasis, Carcinoma, Cystic, Mucinous, Mycobacterium avium complex, Mycobacterium infections, Neoplasms, Pancreatic diseases, Pancreatic ductal". The classic form is seen most commonly in males and is typically associated with other predisposing diseases, especially chronic obstructive pulmonary disease. In general, when pulmonary abnormalities are identified that are consistent with a granulomatous infection, pulmonary MAC needs to be considered along with tuberculosis and fungal infection. To avoid the sternal pain that occurred after every cough episode, this patient used to receive large doses of antitussive drugs. Lady Windermeres Fächer (Lady Windermeres Fan: A Play About a Good Woman) ist eine Gesellschaftskomödie in vier Akten des irischen Schriftstellers Oscar Wilde. Such a scenario would be consistent with Lady Windermere syndrome, in which clinical and radiological changes reflect inflammatory responses but NTM are not cleared from respiratory specimens. UR - http://www.scopus.com/inward/record.url?scp=77953661097&partnerID=8YFLogxK, UR - http://www.scopus.com/inward/citedby.url?scp=77953661097&partnerID=8YFLogxK, Powered by Pure, Scopus & Elsevier Fingerprint Engine™ © 2020 Elsevier B.V, "We use cookies to help provide and enhance our service and tailor content. Working with Dr. Timothy Aksamit at Rochester Mayo Clinic .. he is a saint to have put up with me this long! Case report A 79-year-old woman was referred to our institution because of pancreatic cystic abnormalities and elevated carbohydrate antigen 19-9 (CA 19-9). Diffuse pulmonary opacities and adenopathy are common features. 1st Pulmonary Clinic, General Hospital “G. Lady Windermere syndrome is Mycobacterium avium complex (MAC) pulmonary infection limited to the right middle lobe or lingula, hypothesized secondary to voluntary suppression of cough, responsible for the inability to clear the secretions from the … Radiology of pulmonary Mycobacterium avium-intracellulare complex. Lady Windermere syndrome is a type of mycobacterial lung infection caused by Mycobacterium avium and M. intracellulare (called the “M. Widespread disease is common, as is cavitation. M MAC can also present as a hypersensitivity pneumonitis. No progression was seen until year 6 when MRCP showed a 2 cm pancreatic cancer. title = "The natural history of a branch duct intraductal papillary mucinous neoplasm in a patient with lady windermere syndrome: A case report". No progression was seen until year 6 when MRCP showed a 2 cm pancreatic cancer. At present, our understanding of the natural history of "lowrisk" branch duct IPMN is still evolving. While at our institution, she was also diagnosed with Lady Windermere syndrome. 30(3):572-5. The Lady Windermere syndrome is a special form of pulmonary MAC seen primarily in middle-aged and elderly women. Pulmonary infection with MAC in the immunocompromised patient generally reflects a widespread systemic disease. Cough suppression has been proposed as the mechanism by which the distinctive features of Lady Windermere syndrome (LWS) evolve—involvement limited to the distal portions of the lingula or middle lobe, older female exclusivity, and absence of preexistent pulmonary disease. Pulmonary infection with MAC in the immunocompromised patient generally reflects a widespread systemic disease. In 1992 two physicians published a medical article describing six older women with infection of their lungs by the germ, Mycobacterium avium . Diffuse pulmonary opacities and adenopathy are common features. As such, the radiographic appearance is highly variable. The Lady Windermere syndrome is a special form of pulmonary MAC seen primarily in middle-aged and elderly women. As such, the radiographic appearance is highly variable. In addition, when there is coexistence of Lady Windermere syndrome and pancreatic cancer, prompt diagnosis and treatment of Lady Windermere syndrome should be considered prior to chemoradiotherapy or surgery. Pleural effusions and adenopathy are uncommon. She developed respiratory failure and died after one cycle of gemcitabine. doi = "10.1016/S0272-5231(02)00009-6", https://doi.org/10.1016/S0272-5231(02)00009-6. Mayo Clinic Marketplace. / Levin, David L. T1 - Radiology of pulmonary Mycobacterium avium-intracellulare complex. Features include pulmonary infiltrates, involvement of the lingula or middle lobe, and absence of predisposing disease. No progression was seen until year 6 when MRCP showed a 2 cm pancreatic cancer. Scottsdale, AZ, USA ABSTRACT Context “Low-risk” branch duct intraductal papillary mucinous neoplasm (IPMN) is defined as pancreatic epithelial cellular proliferation of small branch ducts that lack malignant characteristics. Vien X. Nguyen, G. Anton Decker, Ananya Das, M. Edwyn Harrison, Alvin C. Silva, Idris T. Ocal, Joseph M. Collins, Cuong C. Nguyen, Research output: Contribution to journal › Article › peer-review. Dive into the research topics of 'The natural history of a branch duct intraductal papillary mucinous neoplasm in a patient with lady windermere syndrome: A case report'. Although the radiographic appearance of pulmonary MAC infection in the immunocompetent host can be varied, there are several generalizations that can be made. The natural history of a branch duct intraductal papillary mucinous neoplasm in a patient with lady windermere syndrome : A case report. I was terrified of the treatment . Check out these best-sellers and special offers on books and newsletters from Mayo Clinic. Most patients have upper lobe disease with associated pleural thickening. @article{400286e83cb94856bfec4e1c70842f28. Reich and Johnson [ 1] first used the term “Lady Windermere syndrome” in 1992. In their concluding remarks, the authors stated that additional cases of panhypopituitarism with pulmonary MAC infection could provide further insights. Dhillon SS, Watanakunakorn C. Lady Windermere syndrome: middle lobe bronchiectasis and Mycobacterium avium complex infection due to voluntary cough suppression. In general, when pulmonary abnormalities are identified that are consistent with a granulomatous infection, pulmonary MAC needs to be considered along with tuberculosis and fungal infection. Widespread disease is common, as is cavitation. author = "Nguyen, {Vien X.} Lady Windermere syndrome refers to a pattern of pulmonary Mycobacterium avium complex (MAC) infection seen typically in elderly white women who chronically suppress the normal cough reflex. Clin Infect Dis. Usually the first symptom of … By continuing you agree to the use of cookies. “Lady Windermere Syndrome” is an infection of the lungs due to Mycobacterium avium complex, also referred to as MAC. While at our institution, she was also diagnosed with Lady Windermere syndrome. This is known as Lady Windermere syndrome. N2 - Context "Low-risk" branch duct intraductal papillary mucinous neoplasm (IPMN) is defined as pancreatic epithelial cellular proliferation of small branch ducts that lack malignant characteristics. Lady Windermere syndrome is a disorder seen in non-smoking women with no pre-existing pulmonary disease affecting the lingula and/or right middle lobe with Mycobacterium avium-intracellulare complex. Plain radiographs are frequently normal despite active pulmonary infection. The classic radiographic appearance is indistinguishable from that of pulmonary tuberculosis. 4. She developed respiratory failure and died after one cycle of gemcitabine. The radiographic findings are bronchiectasis and small nodules, predominately located within the middle lobe and lingula. Lady Windermere syndrome is a disorder seen in non-smoking women with no pre-existing pulmonary disease affecting the lingula and/or right middle lobe with Mycobacterium avium-intracellulare complex. Patients with Lady Windermere syndrome experience chronic cough, shortness of breath, fatigue and other less specific symptoms. Lady Windermere syndrome is an infection of the lung caused by mycobacterium avium-intracellulare, a bacterium related to the bug that causes tuberculosis. A fastidious nature and a reticence to expectorate are believed to … title = "Radiology of pulmonary Mycobacterium avium-intracellulare complex". Magnetic Resonance Cholangiopancreatography, Endoscopic Retrograde Cholangiopancreatography, The natural history of a branch duct intraductal papillary mucinous neoplasm in a patient with lady windermere syndrome: A case report. Lady Windermere syndrome, in 1992. Especially with pulmonary MAC, radiographic stability over several years does not exclude active disease. Intracellular Mycobacterium avium. Plain radiographs are frequently normal despite active pulmonary infection. Conclusions "Low-risk" branch duct IPMN may be a heterogeneous disease in which some cases can transform into malignant pancreatic neoplasms despite the absence of the so-called "high risk" features on imaging studies. The Lady Windermere Syndrome, which was first described in 1992, comprises a spectrum of reticulonodular opacities, tree-in-bud nodularity, and cavitary lesions superimposed on cylindrical bronchiectasis of the right, middle lobe and lingular segments due to pulmonary mycobacterium avium–intracellulare infection [ 1, 2 ]. The important influence of gender in non-tuberculous mycobacterial infections, also referred to as MAC, is reflected in the name that has been given to this disorder: "Lady Windermere's Syndrome." Clinical management, therefore, requires individualized flexibility. Research output: Contribution to journal › Review article › peer-review. publisher = "E.S. The classic form is seen most commonly in males and is typically associated with other predisposing diseases, especially chronic obstructive pulmonary disease. Clinical management, therefore, requires individualized flexibility. PDF | On Oct 15, 2015, Christopher Donatelli and others published Lady Windermere syndrome: Mycobacterium of sophistication | Find, read and cite all the research you need on ResearchGate Multiple abdominal imaging studies, endoscopic retrograde cholangiopancreatography, computer tomography, and magnetic resonance cholangiopancreatography (MRCP) were performed in the ensuing 6 years, all consistent with "low-risk" branch duct IPMN. Diffuse pulmonary opacities and adenopathy are common features. The radiographic findings are bronchiectasis and small nodules, predominately located within the middle lobe and lingula. Conclusions {"}Low-risk{"} branch duct IPMN may be a heterogeneous disease in which some cases can transform into malignant pancreatic neoplasms despite the absence of the so-called {"}high risk{"} features on imaging studies. Mycobacterium kansasii. Multiple abdominal imaging studies, endoscopic retrograde cholangiopancreatography, computer tomography, and magnetic resonance cholangiopancreatography (MRCP) were performed in the ensuing 6 years, all consistent with {"}low-risk{"} branch duct IPMN. The radiographic findings are bronchiectasis and small nodules, predominately located within the middle lobe and lingula. Mycobacteriumgordonae. At present, our understanding of the natural history of "lowrisk" branch duct IPMN is still evolving. They are carried by several types of rodents, particularly the deer mouse. Lady Windermere syndrome is a disorder seen in non-smoking women with no pre-existing pulmonary disease affecting the lingula and/or right middle lobe with Mycobacterium avium-intracellulare complex. Hantavirus pulmonary syndrome is an infectious disease characterized by flu-like symptoms that can progress rapidly to potentially life-threatening breathing problems.Several types of hantaviruses can cause hantavirus pulmonary syndrome. Clinical management, therefore, requires individualized flexibility. We present a case with pancreatic adenocarcinoma after a six-year surveillance of "low-risk" branch duct IPMN in an asymptomatic elderly white woman with Lady Windermere syndrome. NTM infections may include: 1. Regardless of the clinical situation, pulmonary MAC infection is often omitted from the radiographic differential even when the appearance is characteristic. In addition, when there is coexistence of Lady Windermere syndrome and pancreatic cancer, prompt diagnosis and treatment of Lady Windermere syndrome should be considered prior to chemoradiotherapy or surgery.". Most patients have upper lobe disease with associated pleural thickening. Am delighted at the very bearable side effects! At present, our understanding of the natural history of {"}lowrisk{"} branch duct IPMN is still evolving. Together they form a unique fingerprint. started the first antibiotic September 3, 2011 … am now on all 5 antibiotics for 18 mos to 2 years. We present a case with pancreatic adenocarcinoma after a six-year surveillance of "low-risk" branch duct IPMN in an asymptomatic elderly white woman with Lady Windermere syndrome. It is caused by a specie named mycobacterium avium-intracellulare. Dive into the research topics of 'Radiology of pulmonary Mycobacterium avium-intracellulare complex'. Because of multiple comorbidities, the patient chose chemotherapy over a pancreaticoduodenectomy. The natural history of a branch duct intraductal papillary mucinous neoplasm in a patient with lady windermere syndrome. She developed respiratory failure and died after one cycle of gemcitabine. We present a case with pancreatic adenocarcinoma after a six-year surveillance of {"}low-risk{"} branch duct IPMN in an asymptomatic elderly white woman with Lady Windermere syndrome. These organisms enter hosts via the gastrointestinal tract or the lungs. Nguyen, V. X., Decker, G. A., Das, A., Harrison, M. E. Nguyen, VX, Decker, GA, Das, A, Harrison, ME, Nguyen, Vien X. ; Decker, G. Anton ; Das, Ananya ; Harrison, M. Edwyn. Most often, NTM infections can lead to infections of the lung. The radiographic appearance may be suggestive of the diagnosis of pulmonary MAC, but correlation with the clinical and microbiological data is necessary to confirm the diagnosis. It is named after a character in Oscar Wilde's play Lady Windermere's Fan.. The classic form is seen most commonly in males and is typically associated with other predisposing diseases, especially chronic obstructive pulmonary disease. N2 - Although the radiographic appearance of pulmonary MAC infection in the immunocompetent host can be varied, there are several generalizations that can be made. The classic radiographic appearance is indistinguishable from that of pulmonary tuberculosis. Lady Windermere's Fan, A Play About a Good Woman is a four-act comedy by Oscar Wilde, first performed on Saturday, 20 February 1892, at the St James's Theatre in London.. enables development of a nidus of inflammatory disease at the tip of the lingula or the middle lobe. Lady Windermere syndrome is a disorder seen in non-smoking women with no pre-existing pulmonary disease affecting the lingula and/or right middle lobe with Mycobacterium avium-intracellulare complex. Papanikolaou” Thessaloniki, Panorama, Greece; Pulmonary Clinic, Mayo Hospital and Cardiovascular Surgery Department, Mayo Hospital, Rochester, Minnesota We present a patient with Lady Windermere syndrome after coronary bypass operation. In 1992, Reich and Johnson … The combination of bronchiectasis involving exclusively, or primarily, the right middle lobe and lingula is highly suggestive of pulmonary MAC, even in the face of negative sputum cultures. 2. At present, our understanding of the natural history of "lowrisk" branch duct IPMN is still evolving. The Lady Windermere syndrome is a special form of pulmonary MAC seen primarily in middle-aged and elderly women. The Lady Windermere syndrome is a special form of pulmonary MAC seen primarily in middle-aged and elderly women. @article{1281d913a62044398f900f0b881b3c1e. abstract = "Context {"}Low-risk{"} branch duct intraductal papillary mucinous neoplasm (IPMN) is defined as pancreatic epithelial cellular proliferation of small branch ducts that lack malignant characteristics. CASE REPORT The patient was a 64 -year -old woman, who had no Ib r a Fig. The classic form is seen most commonly in males and is typically associated with other predisposing diseases, especially chronic obstructive pulmonary disease. In general, when pulmonary abnormalities are identified that are consistent with a granulomatous infection, pulmonary MAC needs to be considered along with tuberculosis and fungal infection. MAC is a complex of 3 mycobacterium species which are mycobacterium avium, mycobacterium intracellulare and mycobacterium chimaera. The combination of bronchiectasis involving exclusively, or primarily, the right middle lobe and lingula is highly suggestive of pulmonary MAC, even in the face of negative sputum cultures. DHEA. " Lady Windermere syndrome " is one term to describe infection in the lungs due to MAC. To the Editor: We read with interest the report by Yamakita and Yasuda1 in the February 2005 issue of the Mayo Clinic Proceedings of 2 patients with Mycobacterium avium complex (MAC) lung disease associated with panhypopituitarism. Especially with pulmonary MAC, radiographic stability over several years does not exclude active disease. No progression was seen until year 6 when MRCP showed a 2 cm pancreatic cancer. Regardless of the clinical situation, pulmonary MAC infection is often omitted from the radiographic differential even when the appearance is characteristic. In a poorly drained lung, this usage leads to the development of regions of colonization with Mycobacterium avium complex. We present a case with pancreatic adenocarcinoma after a six-year surveillance of "low-risk" branch duct IPMN in an asymptomatic elderly white woman with Lady Windermere syndrome. Context "Low-risk" branch duct intraductal papillary mucinous neoplasm (IPMN) is defined as pancreatic epithelial cellular proliferation of small branch ducts that lack malignant characteristics. By continuing you agree to the use of cookies. They described 6 elderly women who were immunocompetent, had no significant smoking history or underlying pulmonary disease, and developed Mycobacterium avium complex (MAC) pulmonary infection limited to the right middle lobe or lingula. This is referred to as Lady Windermere’s Syndrome, coined from an Oscar Wilde play which portrayed a woman who involuntarily suppressed her cough. Pulmonary infection with MAC in the immunocompromised patient generally reflects a widespread systemic disease. Because of multiple comorbidities, the patient chose chemotherapy over a pancreaticoduodenectomy. Lady Windermere syndrome Ann Marie Kumfer MD, Hawa Edriss MD AbstrAct Non-tuberculosis Mycobacterium spp (NTM) pulmonary disease is increasing in incidence and is a common cause of undiagnosed lung disease in older patients. drome (lā'dē win'dĕr-mēr sin'drŏm) Nontuberculous mycobacterial pulmonary disease in frail women, usually elderly, often with pectus excavatum or scoliosis. The radiographic findings are bronchiectasis and small nodules, predominately located within the middle lobe and lingula. MAC is the most commonly found form of non-tuberculosis mycobacteria, and it is believed that MAC can be transmitted through inhalation (respiratory tract) or ingestion (into the gastrointestinal tract).