Lady Windermere syndrome is a type of mycobacterial lung infection caused by Mycobacterium avium and M. intracellulare (called the “M. a. complex” or MAC), which are present in soil and water. These organisms enter hosts via the gastrointestinal tract or the lungs. Usually the first symptom of infection is a chronic cough. Subsequent symptoms are similar to tuberculosis: shortness of breath, fatigue, and weight loss.
The name of the syndrome comes from a character in an Oscar Wilde play, Lady Windermere’s Fan, who suffers from tubercular symptoms. It’s debatable whether Lady Windermere actually had an MAC infection, but the name stuck.
I had never heard of Lady Windermere’s Syndrome when I received the following email from a 52 year old woman:
“My name is Tracy, and my sister gave me your email in hopes that you might be able to help me. I will be 52 tomorrow and have recently been diagnosed with Lady Windermere’s Syndrome or mycobacterium avium complex.
As background, 3 weeks ago I was swimming in a friend’s pool and started coughing up blood. All I could think was, ‘This shouldn’t be happening. I’m a healthy person. Do I have tuberculosis? I was in a total state of panic. I checked into the emergency room at Westchester Hospital, and they said we need to do a CAT scan to see what’s going on.
A CAT scan and bronchoscopy were performed. The diagnosis was Lady Windermere’s Syndrome. I have included info on the disease below as well as the antibiotics the doctor at Yale-New Haven Hospital would like me to take for the next 12 months. (Two of the drugs have the potential to cause some liver damage, and one of them requires a baseline with an ophthalmologist because of the effect it can have on the eyes.)
Twenty four years ago I had pleurisy that caused some scarring in my lungs, which the bacteria finds hospitable. This is what the doctor believes. I have led an otherwise healthy life, exercise (yoga, walking, weight training, running, swimming, cycling, etc.), sleep 7-8 hours a night and have one beer a week on Saturday nights.
Would you be willing to work with me, as I have yet to take the drugs because I am concerned about the side effects and would like a separate opinion, hopefully from you? Thank you very much.”
I interviewed her on the phone. Since the hemoptysis incident, she said, her energy has been cut in half. “But I’m fine. I sleep well, feel ok.”
Two months ago she started waking up with “crud” in her lungs, which she would cough up. “Three weeks ago I went on a two mile run, then went swimming afterwards.”
She has not had any fever except during the hospital stay. She keeps reiterating how healthy she is. I asked about the pleurisy.
“I had a very high fever. They gave me antibiotics.”
She has a feeling of not being able to get enough air. “I like a fan on me.”
She gets cold easily, has poor circulation in the extremities, which turn blue.
She loves nuts. She does not like meat or sweets. No skin symptoms; teeth excellent; has one cold per year. She does not get flu shots. That was essentially the case.
From a homeopathic perspective, this is a one-sided case. The air hunger could lead one to Carbo vegetabilis, but there is no bloating or digestive issues to confirm. Since I could not see a clear case for any remedy, I decided to focus on the hemoptysis. Although she was not actively hemorrhaging at this point, it could easily recur. There are many remedies for hemoptysis, however—Acalypha, Senecio aureus, Erigeron, Millefolium, Trillium pendulum, Ferrum phosphoricum, to name a few. Ferrum phosphoricum is known as a kind of remedy of exclusion, useful in cases when there are no distinguishing symptoms.
Rx Ferr-p 30c qd
Follow up 6 days later: “Thanks for checking in. Am steady as she goes. Have been taking Ferrum Phos each day and taking it relatively easy. Am not sure I see a vast improvement but am hoping to be better.”
I was satisfied that the Ferrum Phos was not doing any harm, and I considered it as a kind of insurance policy against further recurrence of the hemoptysis. Now it was time to find a deeper acting medicine, however. Aphorisms 172 through 184 in the Organon deal with one-sided cases. Hahnemann considered such cases less amenable to cure. To paraphrase Hahnemann, his advice to homeopaths is, “Give it your best shot, and if the first remedy doesn’t work or works only partially, it may at least bring out some new symptoms on which to prescribe.”
In this case, however, the Ferrum Phos did not uncover anything, and so I was left pretty much where I started. In thinking about the case, however, what stood out for me was the tubercular nature of her complaints. Chronic lung complaints, hemoptysis and desire for air are decidedly in the tubercular miasm, and so my attention turned to Tuberculinum.
There are three major types of Tuberculinum: T. bovinum, T. aviaire, and Bacillinum Burnett. I was struck by the fact that the causal organism in Lady Windermere Syndrome, Mycobacterium avium, is also the basis of T. aviaire!
Homeopathy is not wysiwyg, as we all know—but sometimes the most obvious remedy choice is also the best! Tracy certainly did not fit the typical Tuberculinum bovinum profile, which tends to be more transgressive. Lou Klein describes Aviaire patients as being more bird-like, i.e., delicate and refined [Miasms and Nosodes]. I found it interesting, moreover, that Tracy’s favorite food was nuts. Don’t birds eat seeds and nuts?! (Continued on p.2)
Rx Tuberculinum aviaire 1M diluted in water, one dropperful per day, alternating with Ferrum Phos once a day at 12 hour intervals, Aug. 16, 2011
Email Aug. 23:
“Have been on the Tuberculinum aviaire for a week, and so far so good. Between the Ferrum Phosphoricum and the new solution, I feel like I am returning to my old, healthier state. I still get tired but have more energy than I have had in the past 4-5 weeks.
Will remain on both until you give me further notice.”
Email Sept. 9:
“I just broke it to my lung doctor that I have not taken any of the medications. Right now I feel like I am almost 100% and just wanted you to see what his response was to my email. The smoldering part is a bit scary. Am still taking Ferrum Phos in the morning and your Tuberculinum aviaire in the evening.”
Here is the email received by Tracy from her pulmonary specialist:
I had thought after you left my office that it would be at best 50/50 that you would fill the prescriptions. I have not been shaking my head, just wanted to make sure that you are OK, and that you understand the rationale for the recommendation:
1) Prevention of recurrence of serious bleeding from your lungs
2) Prevention of further destruction of lung tissue from the smoldering infection.
3) Alleviation of the systemic effects of the MAI infection, such as loss of energy and fatigue.
Ultimately, it is your body, and I have no illusions about the difficulties of taking 3-4 antibiotics daily for a minimum of 12 months, each of which has its own side effects. When you return for a follow up visit, I will be glad to discuss the pro’s and con’s of treatment once again, and to arrange a close monitoring plan if you decide to hold off on antibiotics for the foreseeable future.
I sent her a note explaining that if her symptoms were objectively vanishing as a result of a non-invasive, non-suppressive medicine, then she had nothing to fear from a “smoldering infection.” I also pointed out the pulmonary specialist was operating under the assumption that Tracy was leaving her condition untreated—she had not informed him about the homeopathy, and even if she did, he would not give it much credence.
Email Sept. 19:
“I wanted to give you an update. First, I met with the doctor at the hospital, who put me through a battery of breathing tests, and I passed with flying colors! Thanks so much—I credit you and your healing for that breathing success. The pulmonary specialist has asked to see me in January for a check-up and a CT scan to see what is going on in my lungs. I have not told him about the homeopathic treatment but plan to do so in January. He knows I am not taking any of the drugs he prescribed for me and is OK with that. However, if I start to bleed again, he has asked me to reconsider.
So far I am about 98% back to normal and have started all my various athletic pursuits—walking, zumba, yoga, running, etc. I am excited to be back to normal, and my only holdback could be—menopause?! Have had two hot flashes, missed one period…maybe it is perimenopause? Well, whatever it is, it seems to be presenting itself slowly but surely.”
Long term follow-up:
Tracy took the Aviaire and Ferrum Phos for a total of two months, after which I asked her to stop. There was never a relapse, and her tests in January showed complete remission of the Lady Windermere Syndrome.
In November I prescribed Pulsatilla for her menopausal symptoms, which brought her period back, helped her sleep and cleared up her acne.
In June, 2012, she developed another upper respiratory tract infection. Although she did not go to an MD for a diagnosis, her symptoms suggested walking pneumonia. I prescribed Belladonna 30C tid. After three days she reported, “Am feeling better already. Getting strength back, less foggy, and have expectorated what I believe is most of the stuff in my lungs.” Five days later she wrote: “Am at 99% and think the hot flashes might have been the walking pneumonia or the like. Yet am going through menopause, as I haven’t had my period in 2 months.”
She remained healthy until January of 2013, when she caught the flu. Due to her extreme prostration I prescribed Gelsemium 30C tid, which did not help much. Because of her thirstlessness I prescribed Pulsatilla 30C tid. She had no further trouble.
It has now been over three years since Tracy’s initial diagnosis of Lady Windermere Syndrome, and she remains in good health with no evidence of a “smoldering infection.”