# A Puerto Rican Variant of Lady Windermere Syndrome: Reanalyzing the Characteristics of Non-tuberculous Mycobacterial Infection

## TL;DR

This paper reports a Puerto Rican woman with Lady Windermere syndrome, a non-tuberculous mycobacterial infection typically found in tall, thin white women.

## Contribution

The paper highlights a case that expands the demographic profile of Lady Windermere syndrome to include Puerto Rican women.

## Key findings

- A Puerto Rican woman was diagnosed with Lady Windermere syndrome despite not fitting the typical demographic profile.
- The case emphasizes the importance of considering non-tuberculous mycobacterial infections in patients with TB-like symptoms.
- The rising global incidence of NTM lung disease is linked to aging populations and chronic lung conditions.

## Abstract

Lady Windermere syndrome (LWS) is a disease caused by a non-tuberculous Mycobacterium (NTM) that is commonly found in thin women who voluntarily suppress their cough reflex. The NTM that causes this syndrome is Mycobacterium avium complex, an organism commonly present in chlorinated city water and soil. Patients with LWS are tall, lean, elderly white women. We report a case of an immunocompetent 81-year-old thin Puerto Rican female with a recurrent cough since childhood, who was misdiagnosed with tuberculosis (TB) and prophylactically treated. While the patient fitted the clinical picture of NTM pulmonary infection based on symptoms, imaging, and microbiologic findings, her demography and morphologic features were not completely consistent with published findings. The incidence and prevalence of NTM lung disease are rising worldwide due to the aging population, increased use of immunosuppressive medications, and prevalence of chronic pulmonary obstructive disease and bronchiectasis. The goal of this report is to increase awareness of LWS as one of the diagnoses that should be considered in patients presenting with clinical findings resembling TB and bring attention to the different clinical characteristics this patient with LWS possessed.