Dyspnea with chylothorax: Importance of examining the nails

Abstract

A previously healthy 53-year-old man presented to our department with 2 months of dyspnea. Lung examination revealed a left-sided pleural effusion confirmed on the chest radiograph (Fig. 1A) and CT scan. Physical examination was remarkable for dystrophic fingernails and toenails appeared 3 years ago, with yellowish discoloration, thickening of the nail plates, enhanced transverse curvature of some nails and the absence of lunula and cuticle (Fig. 1B,1C). No lymphedema was present. The pleural fluid appeared milky white with triglycerides > 110 mg/dL and the presence of chylomicrons, consistent with a chylothorax.