Successful living-related liver transplantation in a child with familial yellow nail syndrome and fulminant hepatic failure: report of a case

Yousif M, Abdelmageed I, Eljack MMF, Abbasher Hussien Mohamed Ahmed K, Tarig AbdAlla Mohamed M, Abdelkareim G. Mohammed S, B. Salih E, H. Osman D. Yellow nail syndrome in an elderly sudanese female: A case report

Yellow nail syndrome is a rare lymphatic abnormality without clear pathogenesis. Hereby, we report a 70‐year‐old Sudanese female patient who presented with recurrent cough, recurrent lower limb swelling, and yellowish nail discoloration diagnosed as yellow nail syndrome but unfortunately passed away due to acute respiratory distress syndrome (ARDS).

The co‐existence of recurrent respiratory affection and non‐pitting edema in patients of more than 40 years should raise suspicion of yellow nail syndrome even in absence of sinusitis, bronchiectasis, or positive family history.

Titanium Dioxide in Toothpaste Causing Yellow Nail Syndrome

Yellow nail syndrome (YNS) is an uncommon disorder, the classic triad of which consists of yellow nails, lymphedema, and respiratory symptoms. Few pediatric cases have been reported. We report a 9-year-old girl with yellowish nail discoloration for 1 year accompanied by respiratory symptoms, including chronic cough, recurrent pneumonia, bronchiectasis, and chronic sinusitis. The patient was diagnosed with YNS. Knowing that a relationship between YNS and titanium has been reported, we collected her nail clippings and detected titanium in them by energy dispersive radiograph fluorescence. This patient's titanium exposure may have come from her habit of swallowing children's toothpaste. With meticulous avoidance of swallowing toothpaste, she had amelioration of her yellow nail discoloration as well as diminution of her respiratory symptoms. We reevaluated her nail clippings for titanium 3 years later, and no titanium was detected. This observation suggests that avoiding titanium exposure could alleviate the symptoms of YNS. This is the first report of YNS in a pediatric patient that demonstrates a relationship between YNS and titanium. We review the previous reports of pediatric patients with YNS.

Yellow nail syndrome

PURPOSE OF REVIEW

The yellow nail syndrome (YNS) is a rare disorder of unknown cause characterized by the triad of yellow and thickened nails, lymphedema and respiratory manifestations. We review the current state of knowledge, particularly regarding the diagnosis and management of this disorder.

RECENT FINDINGS

Available data suggest acquired lymphatic dysfunction to be the predominant mechanism underlying the clinical manifestations of YNS. The clinical features are variable among individuals diagnosed to have this disorder, and these features can vary over time. Although many disorders have been reported to be associated with YNS, there is no consistent theme in these associations. Longevity of patients with YNS is modestly reduced when compared with a control population. There is no specific treatment for YNS, but most patients can be managed with supportive measures aimed at ameliorating various clinical manifestations.

SUMMARY

The pathogenesis of YNS remains poorly defined. The diagnosis is established on the basis of characteristic clinical features including abnormal nails, lymphedema and respiratory manifestations. The clinical course is generally benign, and current treatment aims to control the various clinical manifestations of this obscure disease process.