The Subtle evolution of pulmonary parenchymal changes: A case of lady windermere syndrome emerging from chronic MAC infection in an immunocompetent patient with scoliosis.

Mycobacterium avium complex, a commonly seen infection in individuals with a compromised immune system, can also affect people who are immunocompetent. One particularly important manifestation is in elderly females with a competent immune system, involving the middle lobe and lingula lobe of the lung. This is known as Lady Windermere syndrome (LWS). An 84-year-old female patient with certain nonpulmonary comorbidities initially got a diagnosis of MAC infection but refused to undergo any medication therapy, she presents after 5 years for a follow up visit and is found to have significant changes in her pulmonary parenchyma on investigation findings, concerning for this syndrome. LWS is a rather uncommon condition, rarely presents in clinical settings and described very less often in the literature. This report is aimed at increasing awareness of LWS as a possible diagnosis that should be considered in patients with a chronic MAC infection and a specific pattern of parenchymal changes discussed in this report in detail.