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Yellow nail syndrome: A rare entity.

Banerjee A, Kanti-Biswas A, Bala S, Ghosh A - Indian Dermatol Online J (2014)

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, ESI PGIMS and R and ESIC Hospital and ODC, Kolkata, West Bengal, India.

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Sir, Yellow nail syndrome (YNS) is a rare disorder characterized by classical triad of deformed yellow nail, primary lymphedema, and recurrent pleural effusion... Bronchial aspirates were negative for bacterial, mycobacterial growth, and PAP smear... Repeated aspiration of pleural fluid failed to improve symptoms and tetracycline pleurodesis was done after closed tube thoracostomy on the right side leading to marked reduction in pleural effusion and dyspnea... In this case, recurrent pleural effusion, bilateral nonpitting pedal edema and yellow nail prompted us to make the diagnosis of YNS... Yellow nail syndrome usually presents as primary lymphedema, recurrent pleural effusion, and yellowish discoloration of the nail... Since the original description by Samman and White many associations of YNS have been described... This syndrome may have associated bronchiectasis, sinusitis, pericardial effusion, chylous ascites, etc... In the majority of cases, lymphangiography demonstrates hypoplastic, deficient, and sclerotic lymphatic vessels; yellow nail occurs due to altered arterial circulation and Raynaud's disease... Hypoalbuminemia and protein losing enteropathy are due to lymphatic leakage of protein and it is also associated with increased capillary permeability of the walls of villi... Onycholysis, yellowish green, thickened, and excessively curved nails are found in most cases of YNS... Oral and topical vitamin E and clarithromycin are useful in the management of nail abnormality... Intralesional steroid is also effective... Primary lymphedema affects the lower extremity... In this case, diagnosis of YNS was obvious due to the presence of triad namely yellowish thickened nails, primary lymphedema and recurrent bilateral pleural effusion.

No MeSH data available.


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Chest radiograph showing bilateral pleural effusion
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Figure 3: Chest radiograph showing bilateral pleural effusion

Mentions: Chest X-ray showed bilateral pleural effusion more on the right side [Figure 3]. Blood test revealed hypoalbuminemia (2.0 g/dl) and hypoproteinemia (3.9 g/dl). Blood for HIV, HBsAg, HCV, and filarial antigen were negative. Blood gas analysis showed mild hypoxemia. Stool analysis and d-xylose test were normal. Sputum for acid-fast bacillus (AFB) and culture were negative. Mantoux test was negative. radiograph of the paranasal sinuses, barium meal, upper gastrointestinal endoscopy with D2 biopsy, colonoscopy, barium meal follow through and enema, electrocardiogram, and echocardiogram were normal. Abdominal ultrasound scan was normal. Doppler ultrasound of lower limb showed bilateral normal venous flow. Nail scraping for fungal growth was negative.


Yellow nail syndrome: A rare entity.

Banerjee A, Kanti-Biswas A, Bala S, Ghosh A - Indian Dermatol Online J (2014)

Chest radiograph showing bilateral pleural effusion
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4228665&req=5

Figure 3: Chest radiograph showing bilateral pleural effusion
Mentions: Chest X-ray showed bilateral pleural effusion more on the right side [Figure 3]. Blood test revealed hypoalbuminemia (2.0 g/dl) and hypoproteinemia (3.9 g/dl). Blood for HIV, HBsAg, HCV, and filarial antigen were negative. Blood gas analysis showed mild hypoxemia. Stool analysis and d-xylose test were normal. Sputum for acid-fast bacillus (AFB) and culture were negative. Mantoux test was negative. radiograph of the paranasal sinuses, barium meal, upper gastrointestinal endoscopy with D2 biopsy, colonoscopy, barium meal follow through and enema, electrocardiogram, and echocardiogram were normal. Abdominal ultrasound scan was normal. Doppler ultrasound of lower limb showed bilateral normal venous flow. Nail scraping for fungal growth was negative.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, ESI PGIMS and R and ESIC Hospital and ODC, Kolkata, West Bengal, India.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Sir, Yellow nail syndrome (YNS) is a rare disorder characterized by classical triad of deformed yellow nail, primary lymphedema, and recurrent pleural effusion... Bronchial aspirates were negative for bacterial, mycobacterial growth, and PAP smear... Repeated aspiration of pleural fluid failed to improve symptoms and tetracycline pleurodesis was done after closed tube thoracostomy on the right side leading to marked reduction in pleural effusion and dyspnea... In this case, recurrent pleural effusion, bilateral nonpitting pedal edema and yellow nail prompted us to make the diagnosis of YNS... Yellow nail syndrome usually presents as primary lymphedema, recurrent pleural effusion, and yellowish discoloration of the nail... Since the original description by Samman and White many associations of YNS have been described... This syndrome may have associated bronchiectasis, sinusitis, pericardial effusion, chylous ascites, etc... In the majority of cases, lymphangiography demonstrates hypoplastic, deficient, and sclerotic lymphatic vessels; yellow nail occurs due to altered arterial circulation and Raynaud's disease... Hypoalbuminemia and protein losing enteropathy are due to lymphatic leakage of protein and it is also associated with increased capillary permeability of the walls of villi... Onycholysis, yellowish green, thickened, and excessively curved nails are found in most cases of YNS... Oral and topical vitamin E and clarithromycin are useful in the management of nail abnormality... Intralesional steroid is also effective... Primary lymphedema affects the lower extremity... In this case, diagnosis of YNS was obvious due to the presence of triad namely yellowish thickened nails, primary lymphedema and recurrent bilateral pleural effusion.

No MeSH data available.


Related in: MedlinePlus