Yellow Nail Syndrome

Abstract

To the Editor A case of yellow nails associated with pulmonary tuberculosis, tuberculous liver abscess, and diabetes mellitus is reported which is the first documented case of yellow nail syndrome from India. A 62-year-old South Indian man, known to be suffering from chronic pulmonary tuberculosis, was hospitalized in October 1975 with the symptoms of productive cough, fever, breathlessness, and pain in the right hypochondrium. Fingernails of the right hand were rough and yellow; the depth of the color was more in the thumb and index finger. Liver was palpable up to 5 cm below the costal margin. His erythrocyte sedimentation rate was 60 mm/hour, and he was found to be a diabetic. Chest radiography revealed a left-sided apical fibrocavitary lesion and elevation of the right dome of the diaphragm. Direct smear and culture examination of the sputum confirmed tuberculosis. Within three weeks of the admission, he developed increasing pain and fullness over the right lower part of the chest. The liver was palpable up to 10 cm below the costal margin and tender. Tubercle bacilli could be demonstrated in the thick cream-colored fluid aspirated from the liver. Yellow nail syndrome, first described by Samman and White,1Samman PD White WF The yellow nail syndrome.Br J Dermatol. 1964; 76: 154Google Scholar is recognized to be an association of yellow nails, lymphedema, and pleural effusion, although the three abnormalities were not found in all the 48 cases2Angelillo VA O'Donohue Jr, WJ Yellow nail syndrome with reduced glucose level in pleural fluid.Chest. 1979; 75: 84Abstract Full Text Full Text PDF Scopus (7) Google Scholar reported so far. Several other associated abnormalities such as chronic pulmonary and sinus infections, immunologic and thyroid abnormalities, etc were reported of which chronic pulmonary infection was the most common.3Nakielna EM Wilson J Ballon HS Yellow nail syndrome: Report of three cases.Can Med Assoc J. 1976; 115: 48Google Scholar In the case reported here, a hitherto undescribed association of chronic pulmonary tuberculosis, tuberculous liver abscess, and diabetes mellitus with yellow nails was observed. Whether any causal relationship between the abnormalities and the yellow nails exists is a matter of conjecture. Little is known about the pathogenesis of the nail changes, though the syndrome has been attributed to defective lymphatic vessels.2Angelillo VA O'Donohue Jr, WJ Yellow nail syndrome with reduced glucose level in pleural fluid.Chest. 1979; 75: 84Abstract Full Text Full Text PDF Scopus (7) Google Scholar