Yellow nail syndrome associated with rheumatoid arthritis, thiol-compound therapy and early gastric cancer.

1 of 2 DESCRIPTION Yellow nail syndrome (YNS) was fi rst described in 1964 by Samman and White, who noted the association of nail discolouration and leg oedema. 1 Emerson added pleural effusion as the third element of YNS. 2 Hiller et al reported that the respiratory manifestations are diverse and include pleural effusion, bronchiectasis, rhinosinusitis, chronic cough and recurrent lung infections. 3 He also reported that the presence of two of three elements, namely yellow nails, lymphoedema and one the aforementioned respiratory manifestations, has been judged suffi cient for diagnosis. 3 Males and females are equally affected and typically present between the fourth and sixth decades of life. 4 In the present case, bronchiectasis preceded the appearance of yellow nails ( fi gure 1 ) and lymphoedema of the legs ( fi gure 2 ). The triad of yellow nails, lymphoedema and lung involvement is present in only a quarter of patients with YNS. Furthermore, all three criteria are present in 40% to 60% of patients with YNS. 4 The most common conditions associated with YNS include malignancies, connective tissue diseases, endocrine disorders and drugs, including thiol compounds. 4 The present patient had three conditions, namely rheumatoid arthritis, 5 thiol-compound therapy and early gastric cancer. The thiol compound was withdrawn, and endoscopic segment dissection of the gastric cancer was performed, resulting in resolution of the yellow nails ( fi gure 3 ). Images in...