Lady Windermere syndrome: middle lobe bronchiectasis and Mycobacterium avium complex infection due to voluntary cough suppression.

An 81-year-old woman who presented with middle lobe bronchiectasis and Mycobacterium avium complex infection is described. She had a history of habitual suppression of cough, as in Lady Windermere syndrome. She was thin and had mild kyphoscoliosis but had no history of smoking or connective tissue disease. The middle lobe and lingula are predisposed to chronic inflammation because of their particular anatomic structures. Inability to clear the secretions from the airway due to voluntary cough suppression may predispose to bronchiectasis and M. avium complex infection.