Q: 26 year old female is admitted to ICU with shortness of breath, and on exam found to have bilateral pleural effusion, swelling of both legs and yellowish-greenish nails. Consultant diagnosed it as Yellow Nail Syndrome.


Answer: Yellow nail syndrome is characterized by

• pleural effusions
• bilateral lymphedema 
• yellow dystrophic nails

Half of the patients may also have bronchiectasis and chronic sinusitis. Lymphedema is due to underdevelopment of the lymphatic vessels. Genetic link is suspected but not proven. Treatment is symptomatic. Octreotide has been proposed as a treatment particularly when effusion is chylothorax. It is reported to improve lymphedema too.

Reference:

1. Hillerdal G - Yellow nail syndrome: treatment with octreotide. - Clin Respir J. 2007 Dec;1(2):120-1. 

2. Martin Riedel, MD -Images in Cardiovascular Medicine Multiple Effusions and Lymphedema in the Yellow Nail Syndrome - Circulation. 2002; 105: e25-e26