Yellow Nail Syndrome

黄甲综合征
  • 文章类型: Case Reports
    黄甲综合征(YNS)可诱发双侧渗出性胸腔积液;据我们所知,尚未建立YNS的标准治疗方法。本研究描述了一名YNS患者,其胸腔积液由泼尼松龙控制。一名73岁的男子被转介到筑波大学医院(茨城县,日本)抱怨呼吸急促,被诊断为双侧胸腔积液。基于脚趾甲泛黄和生长迟缓的存在,淋巴水肿,病因不明的双侧渗出性胸水,和淋巴闪烁显像上的淋巴充血,患者被诊断为YNS。胸腔积液主要是淋巴细胞性的,对全身性类固醇给药有反应[泼尼松龙30mg/天(0.5mg/kg),持续2周,随后每周缩减]。患者的一般状况和他们的呼吸困难也随着治疗而改善。这些发现表明,全身性类固醇给药应被视为YNS患者的治疗选择之一,这些患者由于可能降低其执行日常活动和呼吸功能的能力而不愿进行胸腔引流或胸膜固定术。
    Yellow nail syndrome (YNS) can induce bilateral exudative pleural effusion; however, to the best of our knowledge, no standard treatment for YNS has been established. The present study describes a patient with YNS for whom the pleural effusion was controlled by prednisolone. A 73-year-old man was referred to the University of Tsukuba Hospital (Ibaraki, Japan) complaining of shortness of breath, which was diagnosed as being due to bilateral pleural effusion. Based on the presence of yellowing and growth retardation of the toenails, lymphedema, bilateral exudative pleural fluid of unknown etiology, and lymphatic congestion on lymphoscintigraphy, the patient was diagnosed with YNS. The pleural fluid was predominantly lymphocytic and responded to systemic steroid administration [prednisolone 30 mg/day (0.5 mg/kg) for 2 weeks, with subsequent weekly tapering]. The general condition of the patient and their dyspnea also improved with treatment. These findings indicated that systemic steroid administration should be considered as one of the treatment options for patients with YNS who are reluctant to undergo chest drainage or pleurodesis due to the potential for a decrease in their ability to perform daily activities and respiratory function.
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  • 文章类型: Case Reports
    黄指甲综合征是一种罕见的疾病,偶尔发生,患病率极低。这种综合征典型地表现为下肢水肿的三联征,黄色指甲,和粘膜问题,如胸腔积液和/或慢性鼻窦炎。三个特征中的两个被认为足以诊断患有黄色指甲综合征的人。我们介绍了一种罕见的黄色指甲综合征,该综合征始于慢性腿部肿胀,后来发展为无症状的胸腔积液,最后是指甲变色。在我们的案例中,患者近期确实有钛植入物全膝关节置换术的重要病史.值得注意的是事件的时间顺序,包括腿部水肿和无症状的胸腔积液,甚至在钛膝盖植入物之前就已经存在。发现指甲硬化和黄色变色的第三个特征是在膝关节置换后发展起来的。有趣的是,关于进一步的评估,他被发现患有IgM缺乏症。
    Yellow nail syndrome is a rare condition occurring sporadically, with an extremely low prevalence rate. This syndrome classically presents with a triad of lower extremity edema, yellow nails, and mucosal issues such as pleural effusion and/or chronic sinusitis. Two out of the three features are deemed sufficient to diagnose a person with yellow nail syndrome. We present a rare case of yellow nail syndrome that began with chronic leg swelling and later progressed to the development of an asymptomatic pleural effusion and finally discoloration of nails. In our case, the patient did have a significant recent history of a total knee replacement with a titanium implant. Of note was the chronology of events including leg edema and asymptomatic pleural effusion which were present even before the titanium knee implant. The third feature of the hardening and yellow discoloration of the nails was found to have developed following the knee replacement. Interestingly, on further evaluation, he was found to have IgM deficiency.
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  • 文章类型: Case Reports
    黄甲综合征是一种病因不明的罕见疾病。患有YNS的患者具有特征性的黄色指甲,肺改变和原发性淋巴水肿。据我们所知,只有少数关于这些患者的尸检结果的报告已经发表.其病因可能涉及较大淋巴管的原发性畸形。我们描述了以前与黄色指甲综合征无关的尸检结果,如纵隔淋巴结和脾窦扩张。目前的尸检揭示了迄今为止未报告的与YNS相关的发现,如脾窦和纵隔淋巴结窦的改变。
    Yellow nail syndrome is a rare disease of unknown aetiology. Patients with YNS have a characteristic yellowish-coloured nails, pulmonary alterations and primary lymphedema. To the best of our knowledge, only a few reports of autopsy findings in these patients have been published. Its aetiology possibly involves a primary malformation of larger lymph vessels. We describe autopsy findings not previously associated with yellow nail syndrome, such as expansion of mediastinal lymph-nodes and splenic sinusoids. The present autopsy reveals hitherto unreported findings associated with YNS, such as alterations in splenic sinusoids and mediastinal lymph-node sinuses.
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  • 文章类型: Case Reports
    黄指甲综合征(YNS)是一种罕见的疾病,最初于1964年描述。它的特点是经典的三合会:黄色的指甲,淋巴水肿,和呼吸道表现。我们介绍了一名71岁的女性,她表现出进行性呼吸困难。病史包括用氨氯地平治疗的高血压。检查显示双侧下肢无凹陷性水肿,指甲变黄,双侧胸腔积液。胸腔穿刺术显示乳糜积液。推定诊断为YNS。假设氨氯地平是间质性水肿的原因,它被阻止了,症状逐渐好转。两个月后,氨氯地平从外部重新启动,呼吸困难复发。再次停用氨氯地平。停用氨氯地平两年后,患者病情良好,无症状。症状的进展和消退表明氨氯地平是YNS的建议原因。注意处方药物是诊断和解决严重并发症的关键。
    Yellow nail syndrome (YNS) is a rare disorder initially described in 1964. It is characterized by a classical triad: yellow nails, lymphedema, and respiratory manifestations. We present a 71-year-old woman who presented with progressive dyspnea. Medical history includes hypertension treated with amlodipine. Examination showed bilateral lower extremity non-pitting edema, yellowish discoloration of nails, and bilateral pleural effusion. Thoracentesis demonstrated chylous effusion. The presumptive diagnosis was YNS. Assuming amlodipine as a cause of interstitial edema, it was stopped, and the symptoms improved gradually. After two months, amlodipine was restarted externally, and the dyspnea relapsed. Amlodipine was discontinued again. After two years of amlodipine cessation, the patient remained well without symptoms. The progression and resolution of symptoms point to amlodipine as a suggested cause of YNS. Paying attention to the prescribed drugs was the key to diagnosing and resolving serious complications.
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  • 文章类型: Case Reports
    背景:隐孢子虫感染导致免疫受损宿主的吸收不良和严重腹泻。黄甲综合征(YNS)和隐孢子虫病的关联很少见,迄今为止尚未报道。在这种情况下,由于YNS与自身免疫性疾病有关,因此免疫力也受到影响。
    方法:这里,我们描述了一例8个月大YNS患者的持续性腹泻病例.改良的ZiehlNeelsen染色和沙红碱-亚甲基蓝揭示了隐孢子虫的卵。经过适当的治疗,患者的症状改善并在血流动力学稳定的情况下出院。
    结论:隐孢子虫病是免疫功能低下患者发病和死亡的重要原因。YNS本身以及包括类固醇在内的治疗导致个体的免疫抑制,使其对诸如隐孢子虫病的机会性感染易感。
    结论:临床医生应了解病情,并在任何具有腹泻症状的免疫功能低下患者中筛查隐孢子虫病。因为像这样的寄生虫感染是机会主义的。
    Cryptosporidium species infection causes malabsorption and severe diarrhea in immunocompromised hosts. Association of Yellow Nail Syndrome (YNS) and Cryptosporidiosis is rare and has not been reported till date. Immunity can also be affected in this case of YNS is associated with autoimmune disorders.
    Here, we describe a case of persistent diarrhea in an 8 month old YNS patient. Modified Ziehl-Neelsen staining and Saffranine-Methylene blue revealed oocyts of Cryptosporidium species. Following appropriate treatment, the patient\'s symptoms improved and the patient was discharged in a hemodynamically stable condition.
    Cryptosporidiosis is a significant cause of morbidity and mortality in immunocompromised patients. YNS per se as well as treatment including steroids leads to immunosuppression in individuals making them susceptible host for opportunistic infections like Cryptosporidiosis.
    Clinicians should be aware of the condition and screen for Cryptosporidiosis in any immunocompromised patients with diarrheal symptoms, as parasitic infection like this are opportunistic in them.
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  • 文章类型: Case Reports
    背景:在大多数黄色指甲综合征(YNS)病例中,黄色指甲的经典三合会,淋巴水肿和呼吸道表现很少同时出现。因此,诊断延迟或经常漏诊。
    方法:我们报告了一名62岁的YNS患者,表现为双侧胸膜,心包和腹膜积液,2个月后,发展为微小变异型肾病综合征。用维生素E治疗后,克拉霉素和泼尼松3个月,胸腔积液,心包和腹腔下降,而尿蛋白水平恢复到正常范围内。
    结论:临床医生应考虑出现多发性浆液性积液和肾病综合征的患者发生YNS的可能性。
    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.
    METHODS: 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.
    CONCLUSIONS: Clinicians should consider the possibility of YNS for patients presenting with multiple serous effusions and nephrotic syndromes.
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  • 文章类型: Case Reports
    黄甲综合征是一种罕见的淋巴异常,发病机制不明确。特此,我们报道了一名70岁的苏丹女性患者,她反复咳嗽,复发性下肢肿胀,黄色指甲变色被诊断为黄色指甲综合征,但不幸因急性呼吸窘迫综合征(ARDS)而去世。
    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).
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  • 文章类型: Journal Article
    Yellow nail syndrome (YNS) is a rare disorder, and diagnosis is based on the clinical findings and the exclusion of other possible causes; the pathogenesis is poorly understood. YNS can be an isolated condition or associated with other diseases; however, YNS associated with multiple myeloma (MM) is rare. A 53-year-old male patient presented with coughing and shortness of breath, and he was diagnosed with YNS with MM. He underwent chemotherapy and achieved a good response. Although the etiology of YNS remains unknown, treating the underlying disease may help prevent or relieve the clinical signs.
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    文章类型: Case Reports
    Yellow nail syndrome (YNS) has traditionally been thought of as a triad of exudative pleural effusion, yellow nails, and lymphedema. More recently, in addition to the hallmark yellowish nail discoloration, the diagnostic criteria required an associated lymphedema and/or chronic respiratory manifestations including pleural effusions, bronchiectasis or chronic sinusitis. Etiology remains unknown and treatment is supportive and directed towards patient\'s specific complaints. While described alongside multiple endocrine, lymphatic and autoimmune disorders, its most ominous association is malignancy, raising YNS as a possible paraneoplastic condition. Here we present the case of an 80 years-old female with worsening restrictive airway disease and acquired yellow nails, with development of dyspnea, cough and leg edema. Recurrent exudative lymphocyte predominant pleural effusion was treated definitively with pleurodesis. Her leg edema and yellow nails were treated conservatively. We describe previous case reports and series in the literature, outline therapeutic options and discuss prognosis.
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  • 文章类型: Case Reports
    Yellow nail syndrome (YNS) is a rare condition characterized by the triad of yellow nails, lymphedema, and respiratory manifestations. Diuretics and thoracic drainage are often not effective in YNS, and the most effective treatments are pleurodesis and decortication/pleurectomy. A 66-year-old man was admitted to our hospital for YNS after esophagectomy with gastric tube reconstruction for esophageal cancer. The patient presented with yellow nails and lymphedema. Chest X-rays and computed tomography showed massive pleural effusions and ascites that were both chylous. The patient was considered to have YNS that became apparent after surgery. He recovered with diuretics and a low-fat diet without pleurodesis and decortication/pleurectomy. Thoracic surgery can exacerbate the functional impairment of lymphatic drainage in patients with asymptomatic and undiagnosed YNS, and can lead to further development of YNS-related clinical symptoms. Despite relatively massive chylothorax following thoracic surgery, chylothorax related to YNS could be successfully controlled with conservative treatment without pleurodesis and decortication/pleurectomy.
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