[Yellow nail syndrome].

A 40 year old man, the son of nonconsanguineous healthy parents of Arab extraction, was hospitalized in our department because of left leg cellulitis. His medical history included bronchiectasis complicated by recurrent respiratory tract infections that necessitated lobectomy at age 20. Since adolescence he had suffered from swollen feet with recurrent leg cellulitis. The patient also displayed recurrent sinusitis. He had never smoked and there was no history of tuberculosis. Similar abnormalities were not reported in his family. Physical examination revealed bilateral lymphedema of both legs and toes, which were covered by thick verrucous skin. The toenails were yellow, overcurved, dystrophic, thick and without Y ellow nail syndrome is a rare syndrome characterized by slow-growing, over-curved yellow nails, bilateral leg lymphedema and lung abnormalities including pleural effusion and bronchiectasis. Other manifestations may include recurrent sinusitis, recurrent respiratory tract infections, pericardial effusion and ocular abnormalities. Since its first description in 1964 [1], the pathogenesis and genetic basis of this syndrome have not been established. We present a case of yellow nail syndrome in which the abnormal dilated vessels in the lymphedematous skin stained positively for D2-40 antibody and vascular endothelial growth factor receptor-3, considered to a cuticle [Figure A]. Chest auscultation demonstrated bilateral, scattered, coarse crackles in the lower lobes. The routine laboratory studies demonstrated normal liver and renal function tests, normal albumin levels and no proteinuria. Repeated mycological cultures obtained from the involved nails were negative. Pulmonary spirometry revealed moderate limitation of the airflow. High-resolution computed tomography scan of the chest showed postoperative changes in the left lower lobe, and mild cylindrical bronchiectasis, mainly in the right lower lobe with sub-segmental atelectasis in the right middle lobe and lingula. Small amounts of pericardial effusion were also seen.