Porpodis et al. Int J Rare Dis Disord 2022, 5:040 Volume 5 | Issue 1 Open Access International Journal of Rare Diseases & Disorders • Page 1 of 5 • Porpodis et al. Int J Rare Dis Disord 2022, 5:040 Citaton: Porpodis K, Filippou I, Tsiouprou I, Kontakiots T (2022) Yellow Nail Syndrome: When Manage- ment Seems More Intriguing Than the Diagnosis. Int J Rare Dis Disord 5:040. doi.org/10.23937/2643- 4571/1710040 Accepted: April 06, 2022; Published: April 08, 2022 Copyright: © 2022 Porpodis K, et al. This is an open-access artcle distributed under the terms of the Creatve Commons Atributon License, which permits unrestricted use, distributon, and reproducton in any medium, provided the original author and source are credited. ISSN: 2643-4571 DOI: 10.23937/2643-4571/1710040 Department of Pulmonology, Aristotle University of Thessaloniki, G Papanikolaou Hospital, Greece Yellow Nail Syndrome: When Management Seems More Intriguing Than the Diagnosis Konstantnos Porpodis, Ioanna Filippou, Ioanna Tsiouprou * and Theodore Kontakiots *Corresponding author: Ioanna Tsiouprou, Department of Pulmonology, Aristotle University of Thessaloniki, G Papanikolaou Hospital, Thessaloniki, Greece, Tel: 00306979751050 Abstract Yellow nail syndrome is a rare condition of unknown etiology, which is defned by the triad of yellow, slowly growing thickened nails, lymphedema, and respiratory manifestations. In order to strengthen the literature on this topic, we report the case of a 64-year-old man with yellow nail syndrome and recurrent pleural efusion. The patient was referred to the Emergency Department because of dry cough and gradually worsening dyspnea over the previous two months. A diagnosis of yellow nail syndrome was based on the presence of nail abnormalities, lymphedema and pleural efusion. He was administered symptomatically with thoracentesis of the left pleural space, initiation of intravenous diuretics and antibiotics and topical nail treatment. However, two years later the patient was readmitted to the hospital due to recurrent pleural efusion, confrming that managing the complications of the syndrome could be more challenging than setting the diagnosis. Keywords Yellow nail syndrome, Pleural efusion, Nail abnormalities Case serIes Check for updates The pathophysiology of the syndrome remains obscure, with hypoplasia of the lymphatc system or an immunological defciency being the most common underlying causes. An associaton with systemic malignancies and drugs (D-penicillamine, gold and bucillamin) has also been described [3,4]. There have been only a few published cases, where a positve family history was reported [5,6]. Treatment is symptomatc and mainly includes pharmaceutcal and interventonal methods unless an underlying disease is diagnosed. The prognosis of yellow nail syndrome is generally good and even spontaneous remission can occur [7]. The purpose of this artcle is to present a rare case of yellow nail syndrome in a 64-year-old male with recurrent pleural efusions and provide a comprehensive review of the literature regarding this unique entty. Case Report A 64-year-old obese man presented to the Emergency Department with dry cough and gradually worsening dyspnea over the previous two-month period. He also reported anorexia, malaise, and myalgia. His medical history was unremarkable, except for arterial hypertension. He was a current smoker with a smoking history of 60 packyears. A year ago, he was admited to hospital due to pleural efusion which was efectvely treated with furosemide. Physical examinaton was notable for hypoxemic respiratory failure along with sinus tachycardia and bilateral pitng lower leg oedema (Figure 1). Lung auscultaton revealed decreased breath sounds at the lef lung base and a subsequent chest X-ray confrmed Introducton Yellow nail syndrome is a rare conditon of unknown etology, which was frst described in 1964 by Samman and White [1]. It is typically encountered among middle- aged people, with both sexes being equally afected. Current evidence suggests that it is characterized by the triad of yellow -slowly growing thickened- nails, lymphedema and respiratory manifestatons, such as pleural efusion, bronchiectasis, bronchial hyperactvity, rhinosinusits, chronic cough and recurrent lower respiratory tract infectons [2]. The presence of two of the three aforementoned criteria is sufcient to set the diagnosis.