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trabajador sanitario&#44; sin antecedentes personales de inter&#233;s ni h&#225;bitos t&#243;xicos conocidos&#44; que refiere cuadro de 3 a&#241;os de evoluci&#243;n consistente en tos no productiva sin predominio horario&#44; disfon&#237;a y exceso de mucosidad en orofaringe&#44; a los que se le suman en el &#250;ltimo a&#241;o astenia y episodios recurrentes de febr&#237;cula&#46; Los resultados de la espirometr&#237;a forzada fueron los siguientes&#58; FEV1&#47;FVC 0&#44;46&#59; FEV1 1&#44;91<span class="elsevierStyleHsp" style=""></span>L &#40;60&#37;&#41;&#59; FVC 4&#44;14<span class="elsevierStyleHsp" style=""></span>L &#40;101&#37;&#41;&#46; La prueba broncodilatadora y las pruebas cut&#225;neas con al&#233;rgenos resultaron negativas&#46; La TC de senos paranasales&#44; el hemograma&#44; el test de cloro en sudor&#44; los niveles de IgG&#44; IgM&#44; IgA&#44; IgE y alfa 1 antipirina se encontraban dentro de la normalidad&#46; La prueba de detecci&#243;n del VIH fue negativa&#46; 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la infecci&#243;n por MAC puede tener 2 formas de presentacio¿n&#58; 1&#41; lesiones fibrocavitarias en los lo¿bulos superiores&#44; que se observa habitualmente en varones de mediana edad y que suele asociarse a una historia previa de tabaquismo y&#47;o alcoholismo y enfermedad pulmonar previa&#44; y 2&#41; lesiones nodulares de menos de 5<span class="elsevierStyleHsp" style=""></span>mm que suelen asociarse con la presencia de bronquiectasias&#46; Estas lesiones tienen predilecci&#243;n por el l&#243;bulo medio y la l&#237;ngula y son m&#225;s frecuentes en el g&#233;nero femenino&#44; siendo conocida dicha entidad como SLW<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a>&#46; Dicho s&#237;ndrome fue descrito en 1992 por Reich y Johnson a partir de 6 casos de mujeres mayores&#44; inmunocompetentes y sin historia significativa de tabaquismo o enfermedad respiratoria previa&#44; que desarrollaban una infecci&#243;n por MAC&#46; Postularon que la supresi&#243;n voluntaria de la tos predispon&#237;a al cuadro al dificultar el drenaje de secreciones&#46; Asimismo&#44; otros factores como son los niveles de leptina o adiponectina y la menopausia<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> tambi&#233;n podr&#237;an jugar un papel en la patog&#233;nesis de esta infecci&#243;n&#46; Nuestro paciente presentaba un cuadro de tos cr&#243;nica en relaci&#243;n con la existencia de reflujo gastroesof&#225;gico&#44; la cual intentaba suprimir al trabajar de cara al p&#250;blico&#44; pudiendo favorecer este acto la infecci&#243;n por MAC&#46; El paciente fue diagnosticado de SLW pese a ser hombre&#44; por cumplir con los criterios cl&#237;nicos&#44; microbiol&#243;gicos y radiol&#243;gicos&#46;</p></span>"
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Carta científica
Síndrome de Lady Windermere. ¿Una entidad exclusiva de mujeres?
Lady Windermere Syndrome: Does It Occur Only in Women?
Juan Marco Figueira Gonçalves
Corresponding author
juanmarcofigueira@gmail.com

Autor para correspondencia.
, Jesús Rodríguez González
Hospital Universitario Nuestra Señora de la Candelaria (HUNSC), Santa Cruz de Tenerife, España
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">En los &#250;ltimos a&#241;os se ha descrito en los pa&#237;ses desarrollados un incremento en la incidencia de infecciones producidas por micobacterias ambientales&#44; adquiriendo una especial relevancia la infecci&#243;n por <span class="elsevierStyleItalic">Mycobacterium avium complex</span> &#40;MAC&#41; en pacientes inmunocompetentes&#59; la enfermedad fibrocavitaria o la presencia de n&#243;dulos y bronquiectasias de localizaci&#243;n predominante en el l&#243;bulo medio y la l&#237;ngula son las principales manifestaciones radiol&#243;gicas<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a>&#46; Esta &#250;ltima&#44; denominada s&#237;ndrome de Lady Windermere &#40;SLW&#41;&#44; ha sido descrita fundamentalmente en mujeres mayores de 50 a&#241;os&#44; siendo su rese&#241;a anecd&#243;tica en varones<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Presentamos el caso de un var&#243;n de 64 a&#241;os de edad&#44; trabajador sanitario&#44; sin antecedentes personales de inter&#233;s ni h&#225;bitos t&#243;xicos conocidos&#44; que refiere cuadro de 3 a&#241;os de evoluci&#243;n consistente en tos no productiva sin predominio horario&#44; disfon&#237;a y exceso de mucosidad en orofaringe&#44; a los que se le suman en el &#250;ltimo a&#241;o astenia y episodios recurrentes de febr&#237;cula&#46; Los resultados de la espirometr&#237;a forzada fueron los siguientes&#58; FEV1&#47;FVC 0&#44;46&#59; FEV1 1&#44;91<span class="elsevierStyleHsp" style=""></span>L &#40;60&#37;&#41;&#59; FVC 4&#44;14<span class="elsevierStyleHsp" style=""></span>L &#40;101&#37;&#41;&#46; La prueba broncodilatadora y las pruebas cut&#225;neas con al&#233;rgenos resultaron negativas&#46; La TC de senos paranasales&#44; el hemograma&#44; el test de cloro en sudor&#44; los niveles de IgG&#44; IgM&#44; IgA&#44; IgE y alfa 1 antipirina se encontraban dentro de la normalidad&#46; La prueba de detecci&#243;n del VIH fue negativa&#46; El estudio baritado del tr&#225;nsito gastroesof&#225;gico revel&#243; la presencia de reflujo&#46; En la TC de t&#243;rax se describe la presencia de bronquiectasias localizadas en el l&#243;bulo medio y la l&#237;ngula asociada a tapones mucosos y n&#243;dulos centrolobulillares distales &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46; La broncofibroscopia result&#243; macrosc&#243;picamente normal&#44; obteni&#233;ndose el aislamiento de <span class="elsevierStyleItalic">Mycobacterium avium complex</span> en el lavado broncoalveolar&#46; El paciente cumpl&#237;a los criterios diagn&#243;sticos para micobacterias ambientales publicados por la American Thoracic Society &#40;2007&#41;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> y fue diagnosticado de infecci&#243;n por MAC compatible con SLW&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">En pacientes inmunocompetentes&#44; la infecci&#243;n por MAC puede tener 2 formas de presentacio¿n&#58; 1&#41; lesiones fibrocavitarias en los lo¿bulos superiores&#44; que se observa habitualmente en varones de mediana edad y que suele asociarse a una historia previa de tabaquismo y&#47;o alcoholismo y enfermedad pulmonar previa&#44; y 2&#41; lesiones nodulares de menos de 5<span class="elsevierStyleHsp" style=""></span>mm que suelen asociarse con la presencia de bronquiectasias&#46; Estas lesiones tienen predilecci&#243;n por el l&#243;bulo medio y la l&#237;ngula y son m&#225;s frecuentes en el g&#233;nero femenino&#44; siendo conocida dicha entidad como SLW<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a>&#46; Dicho s&#237;ndrome fue descrito en 1992 por Reich y Johnson a partir de 6 casos de mujeres mayores&#44; inmunocompetentes y sin historia significativa de tabaquismo o enfermedad respiratoria previa&#44; que desarrollaban una infecci&#243;n por MAC&#46; Postularon que la supresi&#243;n voluntaria de la tos predispon&#237;a al cuadro al dificultar el drenaje de secreciones&#46; Asimismo&#44; otros factores como son los niveles de leptina o adiponectina y la menopausia<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> tambi&#233;n podr&#237;an jugar un papel en la patog&#233;nesis de esta infecci&#243;n&#46; Nuestro paciente presentaba un cuadro de tos cr&#243;nica en relaci&#243;n con la existencia de reflujo gastroesof&#225;gico&#44; la cual intentaba suprimir al trabajar de cara al p&#250;blico&#44; pudiendo favorecer este acto la infecci&#243;n por MAC&#46; El paciente fue diagnosticado de SLW pese a ser hombre&#44; por cumplir con los criterios cl&#237;nicos&#44; microbiol&#243;gicos y radiol&#243;gicos&#46;</p></span>"
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Article information
ISSN: 03002896
Original language: Spanish
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