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Zhang YN, Wang MH, Yu WC, Cheng W, Cong JP, Huang XP, Wang FF. Yellow nail syndrome accompanied by minimal-change nephrotic syndrome: A case report. World J Clin Cases 2022; 10:4949-4956. [PMID: 35801034 PMCID: PMC9198869 DOI: 10.12998/wjcc.v10.i15.4949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 12/27/2021] [Accepted: 04/04/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In most cases of yellow nail syndrome (YNS), the classic triad of yellow nails, lymphedema and respiratory manifestations rarely manifest simultaneously. Therefore, diagnosis is delayed or frequently missed.
CASE SUMMARY We report a 62-year-old YNS patient presenting with bilateral pleural, pericardial and peritoneal effusions who, 2 mo later, developed minimal-change nephrotic syndrome. After treatment with vitamin E, clarithromycin and prednisone for 3 mo, effusions in the chest, pericardium and abdominal cavity decreased while urine protein levels returned to within normal ranges.
CONCLUSION Clinicians should consider the possibility of YNS for patients presenting with multiple serous effusions and nephrotic syndromes.
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Affiliation(s)
- Ya-Nan Zhang
- Department of Respiratory and Critical Care Medicine, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
| | - Mei-Hua Wang
- Department of Respiratory and Critical Care Medicine, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
| | - Wen-Cheng Yu
- Department of Respiratory and Critical Care Medicine, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
| | - Wei Cheng
- Department of Respiratory and Critical Care Medicine, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
| | - Jin-Peng Cong
- Department of Respiratory and Critical Care Medicine, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
| | - Xue-Peng Huang
- Department of Respiratory and Critical Care Medicine, People's Hospital of Rizhao Lanshan, Rizhao 276800, Shandong Province, China
| | - Fang-Fang Wang
- Department of Respiratory and Critical Care Medicine, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
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Abstract
Systemic diseases often manifest with cutaneous findings. Many pediatric conditions with prominent skin findings also have significant pulmonary manifestations. These conditions include both inherited multisystem genetic disorders such as yellow-nail syndrome, neurofibromatosis type 1, tuberous sclerosis complex, hereditary hemorrhagic telangiectasia, Klippel-Trénaunay-Weber syndrome, cutis laxa, Ehlers-Danlos syndrome, dyskeratosis congenita, reactive processes such as mastocytosis, and aquagenic wrinkling of the palms. This overview discusses the pulmonary manifestations of skin disorders.
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Affiliation(s)
- Bernard A Cohen
- Division of Pediatric Dermatology, Johns Hopkins Medical Institutions, 200 N. Wolfe Street, Baltimore, MD 21287, USA.
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Vollono L, Chessa MA, Bruno A, Starace M, Alessandrini A, Piraccini BM. Nails: The Window to the Nose? Update on Yellow Nail Syndrome. Dermatol Pract Concept 2020; 10:e2020031. [PMID: 32363094 DOI: 10.5826/dpc.1002a31] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2019] [Indexed: 12/29/2022] Open
Abstract
Background Yellow nail syndrome is a rare condition characterized by typical nail alterations and variable presence of lymphedema and respiratory disease. The pathogenesis is still obscure, with most of the literature deriving from case reports and few investigations. The most reported respiratory conditions associated with yellow nail syndrome are pleural effusion and bronchiectasis, whereas association with rhinosinusitis is rarer. Objectives To describe a case of yellow nail syndrome and to provide a literature review regarding this disorder, discussing pathogenetic hypothesis, associated conditions, and therapeutic options. Patients/Methods A 49-year-old man presented with arrested growth and alterations of his nails, without any history of previous trauma or inflammation but with a severe nasal septum deviation and a history of chronic rhinosinusitis. A diagnosis of yellow nail syndrome was made. Results Six months after undergoing rhinoseptoplasty and treatment with oral vitamin E, the patient's nails were cured. Conclusions This case emphasizes the role of the dermatologist in detecting systemic conditions. The correct diagnosis led to complete resolution of both nail alterations and associated respiratory disorders.
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Affiliation(s)
- Laura Vollono
- Dermatology Unit, Department of Medicina dei Sistemi, Tor Vergata University, Rome, Italy
| | - Marco Adriano Chessa
- Dermatology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy
| | - Antonio Bruno
- Radiology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy
| | - Michela Starace
- Dermatology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy
| | - Aurora Alessandrini
- Dermatology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy
| | - Bianca Maria Piraccini
- Dermatology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy
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Cousins E, Cintolesi V, Vass L, Stanton AWB, Irwin A, Heenan SD, Mortimer PS. A Case-Control Study of the Lymphatic Phenotype of Yellow Nail Syndrome. Lymphat Res Biol 2019; 16:340-346. [PMID: 30130162 DOI: 10.1089/lrb.2018.0009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Yellow nail syndrome (YNS) is a rare disease manifesting as a triad of yellow-green dystrophic nails, lymphedema, and chronic respiratory disease. The etiology of YNS is obscure and investigations are few. A single lymphatic pathogenesis has been proposed to account for all the associated features, and despite the lack of evidence for a unifying lymphatic mechanism, this hypothesis prevails. The objective was to explore the lymphatic phenotype in YNS and to establish whether lymphatic dysfunction could be a major contributing factor to the disease process. METHODS AND RESULTS Four-limb lymphoscintigraphy was performed on patients with YNS and on healthy, age-matched controls. All 17 patients had lower limb swelling, and 14 (82%) had upper limb swelling also, including 5 (29%) with hand involvement. None of the YNS lymph scans was completely normal. Combined qualitative and quantitative assessment showed that 67% of YNS scans were clearly abnormal compared with 36% of healthy control scans. Mean axillary and ilio-inguinal nodal tracer uptakes were 41%-44% lower in the YNS group than in the controls (p < 0.0001). CONCLUSIONS YNS is a lymphatic phenotype because lymphatic insufficiency was found to exist in all patients and the insufficiency was widespread (upper and lower limbs), with a common mechanistic fault of poor transport. The origin of the lymphatic fault is unclear. In healthy individuals, lymphatic abnormalities may be relatively common in the fifth decade of life onward.
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Affiliation(s)
- Emma Cousins
- 1 Molecular and Clinical Sciences Research Institute (Dermatology Unit), St George's, University of London , London, United Kingdom
| | - Viviana Cintolesi
- 1 Molecular and Clinical Sciences Research Institute (Dermatology Unit), St George's, University of London , London, United Kingdom
| | - Laurence Vass
- 2 Department of Medical Physics and Clinical Engineering, St George's University Hospitals NHS Foundation Trust , London, United Kingdom
| | - Anthony W B Stanton
- 1 Molecular and Clinical Sciences Research Institute (Dermatology Unit), St George's, University of London , London, United Kingdom
| | - Andrew Irwin
- 2 Department of Medical Physics and Clinical Engineering, St George's University Hospitals NHS Foundation Trust , London, United Kingdom
| | - Susan D Heenan
- 3 Department of Radiology, St George's University Hospitals NHS Foundation Trust , London, United Kingdom
| | - Peter S Mortimer
- 1 Molecular and Clinical Sciences Research Institute (Dermatology Unit), St George's, University of London , London, United Kingdom .,4 Department of Dermatology, St George's University Hospitals NHS Foundation Trust , London, United Kingdom
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Abstract
Yellow nail syndrome (YNS; OMIM 153300, ORPHA662) is a very rare disorder that almost always occurs after 50 years of age but a juvenile or familial form has also been observed. YNS is diagnosed based on a triad associating yellow nail discoloration, pulmonary manifestations (chronic cough, bronchiectasia, pleural effusion) and lower limb lymphedema. Chronic sinusitis is frequently associated with the triad. YNS etiology remains unknown but a role of lymphatic impairment is usually evoked. YNS is more frequently isolated but may be associated in rare cases with autoimmune diseases, other clinical manifestations implicating lymphatic functions or cancer and, hence, is also considered a paraneoplastic syndrome. YNS management is symptomatic and not codified. YNS can resolve spontaneously. Oral vitamin E alone or even better when associated with triazole antifungals may achieve partial or total disappearance of nail discoloration. Pleural effusion can be treated surgically, with decortication/pleurectomy or pleurodesis. Antibiotic prophylaxis is prescribed for bronchiectasia with chronic sputum production. Lymphedema treatment is based on low-stretch bandages and the wearing of elastic compression garments combined with skin care, exercises and, as needed, manual lymph drainage.
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Affiliation(s)
- Stéphane Vignes
- Department of Lymphology, Centre National de Référence des Maladies Vasculaires Rares (Lymphœdèmes primaires), Hôpital Cognacq-Jay, 15, rue Eugène-Millon, 75015, Paris, France.
| | - Robert Baran
- Nail Disease Centre, 42, rue des Serbes, 06400, Cannes, France
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Hsu TY, Lin CC, Lee MD, Chang BPH, Tsai JD. Titanium Dioxide in Toothpaste Causing Yellow Nail Syndrome. Pediatrics 2017; 139:peds.2016-0546. [PMID: 27940507 DOI: 10.1542/peds.2016-0546] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/31/2016] [Indexed: 12/17/2022] Open
Abstract
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.
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Affiliation(s)
- Ting-Yuan Hsu
- Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan
| | - Chun-Chen Lin
- Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan.,Department of Medicine, MacKay Medical College, Taipei, Taiwan.,MacKay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
| | - Ming-Dar Lee
- Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan.,Department of Medicine, MacKay Medical College, Taipei, Taiwan
| | - Brian Pin-Hsuan Chang
- Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan.,Department of Medicine, MacKay Medical College, Taipei, Taiwan.,Department of Pediatrics, Taipei Medical University Hospital, Taipei, Taiwan; and
| | - Jeng-Daw Tsai
- Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan; .,Department of Medicine, MacKay Medical College, Taipei, Taiwan.,Department of Pediatrics, Taipei Medical University Hospital, Taipei, Taiwan; and.,Department of Pediatrics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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8
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Dessart P, Deries X, Guérin-Moreau M, Troussier F, Martin L. [Yellow nail syndrome: two pediatric case reports]. Ann Dermatol Venereol 2014; 141:611-9. [PMID: 25288066 DOI: 10.1016/j.annder.2014.06.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Revised: 04/17/2014] [Accepted: 06/19/2014] [Indexed: 01/23/2023]
Abstract
BACKGROUND Yellow nail syndrome (YNS) is a combination of specific nail dystrophy (yellowish or green nails, transverse ridging, increased curvature with "a hump" and distal onycholysis), lymphoedema and respiratory tract involvement (mainly bronchial hyper-responsiveness, recurrent pneumonia, bronchiectasis and pleural effusion), with or without sinusitis. This rare condition is most often seen in middle age. We report two pediatric cases. PATIENTS A 9-year-old boy had 20 yellow nails and lymphedema of the lower and upper left limbs. He was born at 32 weeks of gestation. At birth, he had fetal hydrops with bilateral chylothorax. Since then, he presented bronchopulmonary dysplasia. In his first year of life, he had recurrent nasopharyngitis and serosal otitis. Lymphoscintigraphy was not performed. A 14-year-old boy had 10 yellow toenails and 2 yellow fingernails. He was born at 36 weeks of gestation with fetal hydrops. He had recurrent serosal otitis and asthma attacks. Lymphoscintigraphy showed lymphatic hypoplasia, especially of the left limbs. DISCUSSION These two children have the classic triad of YNS, including yellow nails, lymphedema and respiratory tract involvement. Thirteen cases have been reported in children from birth to 10 years of age, three of whom were siblings, thus suggesting genetic predisposition. In most cases lymphoscintigraphy showed hypoplasia and/or ectasia of lymphatic vessels. These lymphatic abnormalities may be responsible for nail changes as seen in Turner's syndrome. The prognosis of YNS in adults may be serious because of the pulmonary tract involvement. However, it is not known in children. CONCLUSION Yellow dystrophic nails in children may be associated with lymphedema and respiratory tract involvement, as in adults, and this condition should therefore be investigated in cases of YNS.
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Affiliation(s)
- P Dessart
- Service de dermatologie, l'UNAM, CHU d'Angers, 4, rue Larrey, 49933 Angers cedex 9, France
| | - X Deries
- Les Capucins, centre régional de rééducation et de réadaptation fonctionnelle, 28, rue des Capucins, CS 40329, 49103 Angers cedex 02, France
| | - M Guérin-Moreau
- Service de dermatologie, l'UNAM, CHU d'Angers, 4, rue Larrey, 49933 Angers cedex 9, France
| | - F Troussier
- Service de pédiatrie, l'UNAM, CHU d'Angers, 4, rue Larrey, 49933 Angers cedex 9, France
| | - L Martin
- Service de dermatologie, l'UNAM, CHU d'Angers, 4, rue Larrey, 49933 Angers cedex 9, France.
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Piraccini BM, Urciuoli B, Starace M, Tosti A, Balestri R. Yellow nail syndrome: clinical experience in a series of 21 patients. J Dtsch Dermatol Ges 2013; 12:131-7. [PMID: 24134631 DOI: 10.1111/ddg.12216] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 07/29/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND OBJECTIVES The pathogenesis and the therapy of the yellow nail syndrome (YNS) are poorly defined. Our aim was to assess the clinical features, associated diseases and response to treatment of patients with YNS, to help clinicians to better diagnose and treat YNS patients. PATIENTS AND METHODS We studied the medical records of all patients with YNS diagnosed at the Outpatient Nail Clinic of the University of Bologna in the last 28 years. All patients were re-evaluated to assess the evolution of the disease. RESULTS We diagnosed YNS in 21 patients; average age was 57 ± 12.3 years at the time of diagnosis. In most patients YNS involved all 20 nails. Sixteen patients had chronic respiratory manifestations and 6 had lymphedema; 12 patients had other concomitant diseases. Ten of the 20 patients treated had a good nail response to systemic vitamin E 1 200 IU/day, while other symptoms were not modified. CONCLUSIONS YNS is a rare disorder in which the nail alterations are often the symptom that leads to medical consultation. Due to its association with potential serious comorbidity, physicians should be able to diagnose and order further investigations to assess presence of lymphedema and/or lung disease.
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Affiliation(s)
- Bianca Maria Piraccini
- Dermatology, Department of Specialized, Experimental and Diagnostic Medicine, University of Bologna, Italy
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Update March 2013. Lymphat Res Biol 2013. [DOI: 10.1089/lrb.2013.1113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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