A47-06 A Rare Case Presentation of Yellow Nail Syndrome

Yellow Nail Syndrome (YNS) is an uncommon clinical entity characterized by the triad of yellow dystrophic nails, lymphedema, and respiratory manifestations, most notably pleural effusions. Recognition of this syndrome, particularly in elderly patients, is crucial for timely diagnosis and multidisciplinary management. Its etiology remains unclear, with proposed mechanisms including lymphatic dysfunction and autoimmune or paraneoplastic processes. We present a rare case of YNS in a 90-year-old male who presented to the ER after a mechanical fall, with findings on imaging of left sided pleural effusion thus consulted to pulmonary services for possible thoracentesis. Patient had procedure done with pleural fluid findings of an exudative effusion, negative for malignant cells or infection. Given the constellation of symptoms: yellow nails, lymphedema, and pleural effusion, a diagnosis of Yellow Nail Syndrome was made. YNS is a rare disorder, usually affecting individuals in their 50s-70s, with very few reported cases in patients over 90 years of age. Pathogenesis is thought to involve lymphatic insufficiency, although idiopathic and familial forms exist. Nail changes are often the earliest sign but are frequently overlooked. Pulmonary involvement is present in 56-71% of cases and includes, recurrent pleural effusions, as in the case of our patient that reported multiple thoracentesis in the past with no further work up. Our patient underwent thoracentesis with symptomatic relief. Compression stockings were initiated for lymphedema, and he was referred to dermatology. Due to age and comorbidities, invasive diagnostics were minimized. This case highlights the importance of considering YNS in the differential diagnosis of unexplained pleural effusions, particularly in patients with nail changes and lymphedema and history of chronic sinusitis. Though rare, timely diagnosis can aid in symptom management and reduce unnecessary investigations. This abstract is funded by: None