Dr. Hany Abo Alwafa case

Yellow nail syndrome, also known as “primary lymphoedema associated with yellow nails and pleural effusion”

– Rare disorder characterized by triad of:

1- Nail Changes: Yellowish discoloration, Thickening , Clubbing (thumb & index finger), onychomadesis (Big toes), and may be Onycholysis (Right middle finger)

2- Lymphoedema: in 80% of cases usually affects the lower legs (Absent in our case)

3- Pulmonary symptoms: in 30% of cases, most commonly pleural effusion & Bronchiectasis.

Other less reported problems include Chronic bronchitis& sinusitis (as in this case)

– There presence of nail changes plus either Lymphoedema or pulmonary problems is sufficient for diagnosis of Yellow Nail syndrome

Etiology: unknown but may be linked to:

1- Genetics: Although it has been described in families, it has been suggested that it might not have a genetic link

2- Associated with : – Chronic bronchiectasis or sinusitis, pleural effusions – Rheumatoid Arthritis – Internal malignancy – Drugs: e.g. penicillamine, bucillamine, gold sodium thiomalate& titanium from dental implants

Treatment: “No specific therapy”

1- Treatment of underlying associations: Pulmonary disorders, edema, malignancy, rheumatoid arthritis.

2- Some reports support the use of : – Vitamin E, Zinc – Fluconazole & itraconzaole ( bothe appear to speed up the rate of growth of nails)