Massive hemoptysis in mycobacterium abscessus lung disease: Interventional management with bronchial artery...

In older women without traditional risk factors, Lady Windermere syndrome is a recognized phenotypic presentation of non-tuberculous mycobacterial (NTM) pulmonary disease that is traditionally linked to Mycobacterium avium complex (MAC) infection. It is characterized by a nodular-bronchiectatic pattern that usually affects the lingula and right middle lobe. Hemoptysis is a known sequence of NTM, severity of which may vary from minor episode to multiple, fatal. We present a case of a female treated case of tuberculosis and then presenting with massive hemoptysis. Radiological assessment showed bronchiectasis and nodular infiltrates in the right middle lobe consistent with Lady Windermere syndrome. Sputum examination confirmed the growth of mycobacterium abcessus. Hemoptysis caused by this infective agent was massive and non-refractory to medical treatment. Bleeding from several feeder vessels was promptly controlled by an urgent bronchial artery embolization. Patient was started on targeted, evidence based treatment regimen for mycobacterium abcessus and had reserved lung functions, maintained sputum conversion and was symptomatically better at an 18- months follow-up. This case highlights the association of non-mycobacterium with hemoptysis severe enough to require bronchial artery embolization. For best results, it emphasizes on the necessity for a multidisciplinary strategy that combines the management of an infectious illness with radiological intervention.