Yellow nails syndrome: complete triad

An 83‐year‐old male non‐smoker presented with chronic purulent cough. On physical examination, xanthonychia (yellow discoloration), onychauxis (thickened nails), onycholisis (separation of the nail from the nail bed), enhanced transverse curvature, and scleronychia (hardening and thickening of the nails) were observed (Figure, A). He had a 5 year history of decreased longitudinal nail growth and progressive adult onset bilateral lower limb lymphoedema. Findings on computed tomography scan demonstrated severe bilateral cystic bronchiectasis (Figure, B and C). Yellow nails syndrome is a disorder characterised by the triad of yellow thickened nails, lymphoedema and respiratory manifestations, typically chronic cough, bronchiectasis or pleural effusion. All three features appear in only 27–60% of patients.1 Treatment is symptomatic and includes antibiotic prescription for bronchiectasis and oral vitamin E alone or combined with triazole antifungals for yellow nails, achieving partial to complete responses.1