Nail Patella Elbow Syndrome Presenting with Depression: A Case Report

Abstract

Nail-Patella Syndrome (NPS) is a rare autosomal dominant illness. Patients typically exhibit a tetrad of dysplastic finger or toenails, elbow dysplasia, hypoplastic or missing patellae, and iliac horns as their first musculoskeletal and dermatological symptoms. A higher occurrence of psychiatric disorders, such as depression and attention deficit hyperactivity disorder, has also been reported with NPS. This is a rare case of NPS, presenting with depression as the major symptom in an 18-year-old young girl who presented to the psychiatry Outpatient Department (OPD) with depressive symptoms like persistent low mood, loss of pleasure or anhedonia, loss of appetite, disturbed sleep, and thoughts of death. After 10 days of treatment with antidepressant drugs like Benzodiazepines, she was discharged and followed-up on an OPD basis. After a thorough evaluation, hypoplastic patella, swan-necked nails, radial head subluxation, and right eye glaucoma were also noted, and a final diagnosis of Nail-Patella Syndrome was made. A case of NPS can present in any department, such as in Medicine for nail dysplasia, in Orthopaedics for elbow or patella dysplasia, or in Dermatology for iliac horns. Here, the case was primarily presented to the Psychiatry department and later managed by a team of physicians, orthopaedicians, and psychiatrists. Careful illustration of the family history reveals more cases.