SHM Converge Scientific Abstract ePoster Gallery-A Rare Diagnosis of Yellow Nail Syndrome

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This case describes a 70-year-old man with bronchiectasis, polymyalgia rheumatica, and progressive neutropenia who presented with shortness of breath, bilateral pleural effusions, lower extremity edema, weakness, lethargy, and weight loss. He had a recent thoracentesis showing a lymphocytic-predominant exudative pleural effusion without malignancy. On exam, he had yellow discoloration and clubbing of all fingernails and toenails, along with leg edema.<br /><br />A broad workup for neutropenia, pleural effusions, and possible autoimmune or infectious causes was unrevealing. Nutritional studies, extensive infectious testing, bone marrow biopsy, pleural fluid cytology and cultures, ADA testing, and rheumatologic evaluation were all negative or non-diagnostic.<br /><br />The patient was ultimately diagnosed with Yellow Nail Syndrome, a rare disorder thought to result from abnormal lymphatic drainage and characterized by a triad of yellow nails, respiratory manifestations such as bronchiectasis or pleural effusions, and peripheral edema. The syndrome is uncommon, with only a few hundred cases reported.<br /><br />Treatment is mainly supportive. In this patient, filgrastim was given for idiopathic neutropenia, with improvement.<br /><br />Key takeaways:<br />1. Each abnormality should be investigated individually, but clinicians should also consider whether a single diagnosis can explain the entire presentation.<br />2. Yellow Nail Syndrome should be considered in older patients with unexplained respiratory symptoms, pleural effusions, edema, and yellow nails.

Asset Subtitle

Arrush Choudhary

Meta Tag

Author List Arrush Choudhary, Brittne Halford, Sean Levy

Category Clinical Vignettes

Concept Yellow Nail Syndrome

Concept Yellow Nails

Concept Sinopulmonary Disease

Concept Pleural Effusion

Concept Lower Extremity Edema

Distinguished Non-Finalist

Presenter Organization Beth Israel Deaconess Medical Center

Presenting Author Arrush Choudhary

Track Adult

Keywords

Yellow Nail Syndrome

bronchiectasis

pleural effusion

yellow nails

peripheral edema

neutropenia

lymphatic drainage

clubbing

polymyalgia rheumatica

filgrastim

Yellow Nail Syndrome

Yellow Nails

Sinopulmonary Disease

Pleural Effusion

Lower Extremity Edema