A 52-yo female presents with a non-productive cough and fatigue of 3 months duration. She claims she has had intermittent dyspnea, a wet cough and often has difficulty ambulating. While measuring her vitals you note her nails (See image), which she claims have been discolored for at least 2 years. Blood work reveals low albumin but the rest is normal. In general, what other clinical feature is frequently associated with this pathology?
a. Ascites
b. Elevated lead levels
c. Hemolytic anemia
d. Carotenemia
e. Ectopic ACTH secretion
f. Ovarian mass
g. Lymphedema
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Yellow nail syndrome usually presents between the fourth and sixth decades of life and is thought to be an acquired condition.
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It may be idiopathic, secondary to another condition (e.g., connective tissue disease, a thyroid disorder or malignancy) or an adverse effect of drugs (e.g., penicillamine, bucillamine or gold sodium thiomalate).
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Diagnosis is based on the presence of yellowish discoloration of the nails and lymphedema or respiratory manifestations. Respiratory findings may include effusions, bronchial hyper-responsiveness, bronchiectasis, bronchitis and sinusitis.
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The classic triad of yellow nails, lymphedema and pleural effusion is simultaneously present in only a quarter of patients with the syndrome. Discoloration of the nails is the most consistent finding. A third of patients have pleural effusions.
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The long-term outcome for yellow nail syndrome is variable and related to the type and severity of associated conditions. The syndrome is associated with reduced survival compared with the general population, and remissions and relapses can occur
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