Non-Obstructive Middle Lobe Syndrome: An Unusual Cause of Recurrent Pneumonia in an Elderly Woman

  • João Rua Serviço de Medicina Interna B, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
  • Ricardo Marques Serviço de Medicina Interna B, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
  • Rafael Silva Serviço de Medicina Interna B, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
  • Bráulio Gomes Serviço de Medicina Interna B, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
  • Jorge Fortuna Serviço de Medicina Interna B, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal

Abstract

An 84-year-old woman had five episodes of pneumonia in 4 months. Despite extensive comorbidities and advanced age, her health status was good and the recurrence seemed unjustified. Exhaustive background investigation revealed 14 episodes of right-sided pneumonias during the 3 previous years and an inconclusive investigation with CT of the thorax and bronchofibroscopy, despite some fibrotic and atelectasic alterations in the right middle lobe. A new right-sided x-ray showed a wedge-shaped density extending anteriorly and inferiorly from the hilum, and CT of the thorax revealed aggravated middle lobe abnormalities with thickening of the bronchial wall and segment atelectasis, without any visible airway obstruction. After extensive work-up had excluded other causes of recurrent pneumonia and immunodeficiency, a non-obstructive middle lobe syndrome (MLS) was deemed responsible for the repeated episodes of pneumonia. MLS is characterised by chronic hypoventilation and atelectasis of the middle lobe, facilitating secretion accumulation, chronic inflammation and repeated infection. After treatment with bronchodilators and immunostimulants was initiated, the patient experienced no recurrences for several months.

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  • Published: 2017-11-23

    Issue: Vol 5 No 1 (view)

    Section: Articles

    How to cite:
    Rua, J., Marques, R., Silva, R., Gomes, B., & Fortuna, J. (2017). Non-Obstructive Middle Lobe Syndrome: An Unusual Cause of Recurrent Pneumonia in an Elderly Woman. European Journal of Case Reports in Internal Medicine, 5(1). https://doi.org/https://doi.org/10.12890/2017_000737