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Lady Windermere syndrome describes infection in the lungs due to Mycobacterium avium complex.
It is named after a character in Oscar Wilde's play Lady
Lady Windermere syndrome is a type of mycobacterial lung
Patients with Lady Windermere syndrome experience chronic cough,
shortness of breath, fatigue and other less specific symptoms.
Mycobacterium avium complex is the most
commonly found form of non-tuberculous mycobacteria.
Immunodeficiency is not a requirement for Mycobacterium
Mycobacterium avium Complex (MAC) usually affects
patients with abnormal lungs or bronchi.
However, Candace Baker, Jerome Reich and Richard Johnson describe a
series of six patients with MAC infection of the right middle lobe
or left lingula who did not have any predisposing lung
The right middle lobe and left
lingula of the lungs are served by
that are oriented downward when a person is in the upright
position. As a result, these areas of the lung may be more
dependent upon vigorous voluntary expectoration (cough) for clearance of bacteria and
Since the six patients in their retrospective case series were
older females, Reich and Johnson and Baker propose that patients
without a vigorous cough may develop right middle lobe or left
lingular infection with MAC. They propose that this syndrome be
named Lady Windermere syndrome, after the character Lady Windermere
in Oscar Wilde's
play Lady Windermere's Fan.
The diagnosis requires consistent symptoms with two additional
Lady Windermere syndrome is usually treated with a three-drug
regimen of either clarithromycin or azithromycin, plus rifampicin and ethambutol. Treatment
typically lasts at least 12 months.
The original Chest article proposing the existence and
pathophysiology of the Lady Windermere
syndrome suggests that the character Lady Windermere in Oscar Wilde's
Victorian-era play Lady Windermere's Fan is a good
example of the fastidious behavior believed to cause the syndrome.
The article states:
- We offer the term, Lady Windermere's Syndrome, from the
Victorian-era play, Lady Windermere's Fan, to convey the fastidious
behavior hypothesized: "How do you do, Lord Darlington. No, I can't
shake hands with you. My hands are all wet with the roses."
Victorian women presumably believed that "Ladies don't spit,"
and consequently might have been predisposed to develop lung
Shortly after the Lady Windermere syndrome was proposed, a
librarian wrote a letter to the editor of Chest
 challenging the use of Lady
Windermere as the eponymous ancestor of the proposed syndrome. In
Lady Windermere's Fan, Lady
Windermere is a vivacious young woman, married only 2 years, who
never coughs or displays any other signs of illness. While her
avoidance of shaking hands might be interpreted as
"fastidiousness," two alternative explanations may be just as
- 1) Lady Windermere actually is in the midst of
arranging flowers and consequently cannot properly greet her
- [LADY WINDERMERE is at table R., arranging roses in a blue
- 2) Lady Windermere wishes to discourage the flirtatious
advances of her would-be suitor Lord Darlington and cites her wet
hands as an excuse to keep him from touching her:
- LADY WINDERMERE. Lord Darlington, you annoyed me last night
at the Foreign Office. I am afraid you are going to annoy me again.
. . .
- LORD DARLINGTON. [Takes chair and goes across L.C.] I am
quite miserable, Lady Windermere. You must tell me what I did.
[Sits down at table L.]
- LADY WINDERMERE. Well, you kept paying me elaborate
compliments the whole evening.]
The scholars highlight the literary malapropism, but
some in the medical community have adopted the term regardless, and
peer-reviewed medical journals still sometimes mention the Lady
In recent years, some have described the eponym as
and some have noted that it would have been unlikely that Lady
Windermere had the condition to which her name was assigned.
- ^ Reich JM, Johnson RE (June 1992). "Mycobacterium avium complex
pulmonary disease presenting as an isolated lingular or middle lobe
pattern. The Lady Windermere syndrome". Chest
101 (6): 1605–9. doi:10.1378/chest.101.6.1605. PMID 1600780. http://www.chestjournal.org/cgi/reprint/101/6/1605.
- ^ Wilde, Oscar (1940). The Importance of
Being Earnest and Other Plays. Penguin. ISBN
- ^ Subcommittee Of The Joint Tuberculosis
Committee Of The British Thoracic Society, (March 2000). "Management of opportunist
mycobacterial infections: Joint Tuberculosis Committee Guidelines
1999. Subcommittee of the Joint Tuberculosis Committee of the
British Thoracic Society". Thorax 55
(3): 210–8. doi:10.1136/thorax.55.3.210. PMID 10679540. PMC 1745689. http://thorax.bmj.com/cgi/pmidlookup?view=long&pmid=10679540.
Wickremasinghe M, Ozerovitch LJ,
Davies G, et al. (December 2005). "Non-tuberculous
mycobacteria in patients with bronchiectasis". Thorax
60 (12): 1045–51. doi:10.1136/thx.2005.046631. PMID 16227333.
- ^ Martins AB, Matos ED, Lemos AC (April
2005). "Infection with the
Mycobacterium avium complex in patients without predisposing
conditions: a case report and literature review". Braz J
Infect Dis 9 (2): 173–9. doi:/S1413-86702005000200009. PMID 16127595. http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-86702005000200009&lng=en&nrm=iso&tlng=en.
^ "Chest -- eLetters for Reich
and Johnson, 101 (6) 1605-1609". http://www.chestjournal.org/cgi/eletters/101/6/1605#85.
b "Oscar Wilde: Lady
Windermere's Fan: ACT I. Morning-room in Lord Windermere's house. -
Free Online Library". http://wilde.thefreelibrary.com/Lady-Windermeres-Fan/1-1.
- ^ Sexton P, Harrison AC (June 2008). "Susceptibility to
nontuberculous mycobacterial lung disease". Eur. Respir.
J. 31 (6): 1322–33. doi:10.1183/09031936.00140007. PMID 18515557. http://erj.ersjournals.com/cgi/pmidlookup?view=long&pmid=18515557.
- ^ Kasthoori JJ, Liam CK, Wastie ML (February
2008). "Lady Windermere syndrome: an
inappropriate eponym for an increasingly important condition"
(PDF). Singapore Med J 49 (2): e47–9. PMID 18301826. http://smj.sma.org.sg/4902/4902cr6.pdf.
- ^ Rubin BK (October 2006). "Did Lady Windermere have
cystic fibrosis?". Chest 130 (4):
937–8. doi:10.1378/chest.130.4.937. PMID 17035420. http://www.chestjournal.org/cgi/pmidlookup?view=long&pmid=17035420.
diseases · Bacterial diseases: G+ (primarily
A00–A79, 001–041, 080–109)