Akademik Veri Yönetim Sistemi
20th International Congress of Update in Cardiology and Cardiovascular Surgery, June 6-9, 2024, İstanbul, Türkiye, 6 - 09 Haziran 2024, ss.60-61, (Özet Bildiri)
Recommended Approach for Yellow Nail Syndrome in Isolated Pericardial Effusion: What
Should We Do in Very Rare Cases?
BACKGROUND: Yellow Nail Syndrome is a rare condition characterized by the presence of at least two of the following: thickened and yellow-discolored nails, lymphedema, and respiratory tract involvement. The exact cause of this syndrome is not well understood.
Although pericardial effusion without pleural effusion is uncommon, this condition typically results in lymphedema in the lower extremities, recurrent pleural effusion, bronchiectasis, chronic sinusitis, and cough. In surgical treatment for pericardial effusion, careful planning is necessary to account for the possibility of recurrence.
METHODS: A fifty-two-years-old male patient was admitted due to cough, shortness of breath and edema in the legs, which started two months ago. He was diagnosed with yellow nail syndrome seven years ago, and Echo-guided percutaneous pericardiocentesis was performed at an external center due to pericardial effusion one-and-half months ago. The patient was relieved after pericardiocentesis, but when the complaints recurred a short time later, the patient was recommended a sternotomy at an external center. There was no history of occupational exposure, drug use or additional chronic disease. The patient, who
quit smoking five years ago, had thirty pack-years of smoking. Physical examination revealed
significant thickening, yellow discoloration, dysmorphic appearance and lunula loss in all fingernails and toenails. Heart sounds sounded deep. He had prolonged expiration, pitting edema in both lower extremities, and hardening of the skin. No additional pathology was detected in other system examinations. Low voltage was observed on ECG. Echocardiography showed a 1.5 cm pericardial effusion. Thorax-CT showed only 1.5 cm thick pericardial effusion. Complete blood count, metabolic parameters and acute phase reactants were normal.
RESULTS: In surgical treatment, left mini thoracotomy was used to open the pericardial window and a tube thoracostomy was performed. Pericardial effusion sample resulted in exudate. Pericardial fluid was negative for acid-fast microorganisms and adenosine deaminase level was within the normal range. Rheumatoid factor and other immunological markers were found to be negative. No hypermetabolic area was observed in the PET-CT image performed for possible malignancy control. The patient was started on 400 mg oral vitamin-E three times a day and 0.5 mg colchicine twice a day and was closely monitored.
CONCLUSIONS: Yellow nail syndrome is primarily characterized by pleural effusion, lymphedema and nail changes. Malignancies and autoimmune diseases may accompany the syndrome. Pericardial effusion without pleural fluid has been reported very rarely in the literature. Yellow nail syndrome should be kept in mind in the presence of nail changes and lymphedema in patients presenting with recurrent pericardial tamponade. We think that choosing a minimally invasive approach in surgical planning for tamponade against the possibility of recurrence is important in terms of patient recovery and comorbidity.
References:
Soong LC, Haber RM. Yellow Nail Syndrome Presenting With a Pericardial Effusion: A Case Report and Review of the Literature. J Cutan Med Surg. 2018;22(2):190-193. doi:10.1177/1203475417738970
Abdalla A, Jamous F. Yellow Nail Syndrome: A Case Presentation and a Review of Management Options. S D Med J S D State Med Assoc. 2021;74(8):368-371.
Mazumder S, Karmali R, Sankar P, et al. Recurrent Pericardial Effusions and Pericarditis Due to Yellow Nail Syndrome. JACC Case Rep. 2023;11:101797. doi:10.1016/j.jaccas.2023.101797
Keyword: yellow-nail syndrome, pericardial effusion, minimally invasive