Page 23 - Delaware Medical Journal - February 2016
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MEDICAL STUDENT ABSTRACTS
TABLE 1: Diagnostic Criteria for Yellow Nail Syndrome
• Yellow Nails
• Peripheral Edema
• Pleural Effusions
overlooked were his progressive dyspnea, which had been refractory to antibiotics in conjunction with his musculoskeletal symptoms.
A differential diagnosis of rheumatologic diseases that affect the lungs by causing ILD should prompt a work-up that will lead to the correct diagnosis. Patients with polymyositis need to be monitored for the development of ILD, as it is the worst aspect of the disease.
First Place – Poster Competition
Anita Modi MS IV, Sidney Kimmel Medical College of Thomas Jefferson University; and John F. Reinhardt, MD,, Department of Medicine, Christiana Care Health System, Newark, Del.
Introduction: slow-growing yellowed nails, lymphedema, and pleural effusions 1927, this condition results from impaired peripheral circulation, causing poor nail growth and hypoplastic lymph vessels. Poor lymphatic drainage precipitates peripheral edema and pleural effusions with associated respiratory symptoms such as persistent cough and sinusitis, for which patients usually present to primary care settings. The following case presentation chronicles the collaborative evaluation of a patient with yellow nail syndrome secondary to allergic bronchopulmonary aspergillosis.
Case Description: The patient is a 66-year-old man with a past obstructive pulmonary disease secondary to tobacco smoking. He reports a two-year history of recurrent sinus infections, beginning upon his return to the United States from a trip to Costa Rica.
to provide adequate relief. He was subsequently evaluated by
an otolaryngologist with a CT scan demonstrating mild sinus polyposis. The patient later noticed the progressive onset of yellow toenails. The nails became yellow and opaque in color, thickening and curving with time.
He was referred to a dermatologist, who ruled out fungal infection via nail cultures. Given the patient’s respiratory symptoms, a CT
scan was ordered and demonstrated patchy ground glass densities of the right upper/middle lobes and both lower lobes with intralobular nodules. The patient was referred to infectious disease for further penicillin-resistant Streptococcus pneumonia and Aspergillus fumigatus. Blood work revealed elevated IgE levels to 512. The patient’s history of asthma, central bronchiectasis, elevated IgE levels, and documented Aspergillus fumigatus all led to the diagnosis of allergic bronchopulmonary aspergillosis. He additionally met criteria for yellow nail syndrome, a clinical diagnosis (Table 1). He with improvement of nail growth and respiratory symptoms.
Discussion: Yellow nail syndrome is a rare condition characterized by slow-growing yellowed nails, lymphedema, and pleural effusions leading to respiratory symptoms. While thickened, yellowed nails nail syndrome is important to ensure appropriate management of underlying respiratory disease and further evaluation for associated conditions (Table 2).
REFERENCE
Maldonado F, Ryu JH. Yellow Nail Syndrome. Curr Opinion Pulmonary Med. 2009;15:371-375.
TABLE 2: Conditions associated with Yellow Nail Syndrome
• Malignancies (ie. bronchogenic carcinoma, breast cancer, endometrial carcinoma)
• Immunodeficiency states
• Connective tissue disorders
• Endocrine disorders (ie. diabetes mellitus,
thyroid dysfunction)
• Obstructive sleep apnea
• Tuberculosis
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