Yellow Nail Syndrome: An Unusual Cause of Pleural Effusion

Abstract

Yellow Nail Syndrome (YNS) is a rare clinical syndrome characterised by the classical triad of thickened and dystrophic yellow nails, pleural effusion, and primary lymphoedema. It usually occurs in older adults of over 50 years but there is no sex predilection. This was a case report of a 21-year-old male, who presented with dyspnoea on exertion, dry cough and abdominal distension for past 15 days and bilateral lower limb swelling for past two years. On general examination, patient had pallor with bilateral non pitting oedema of lower limbs and had yellow thick and dystrophic nails. There was clinical evidence of pleural effusion and ascites. Pleural fluid analysis showed lymphocytic and exudative picture with low Lactate Dehydrogenase (LDH) and Adenosine Deaminase (ADA) levels and was negative for malignancy. Duodenum second part (D2) biopsy showed Primary Intestinal Lymphangiectasia (PIL). Hence, a final diagnosis of YNS was confirmed. Symptomatic management was done, following which the patient had relief of symptoms and in subsequent follow-ups the patient was doing better. A detailed clinical history with investigations helps in attaining the diagnosis. Although there is no definitive treatment, diagnosis helps in avoiding unnecessary treatment and symptom based management helps in improving the quality of life of the patient.

Keywords

• dystrophic nails
• lymphangiectasia
• lymphoedema
• non pitting oedema