A 16-year-old boy presented to us with recurrent chest infections, swelling of both lower limbs and discoloration of nails. Nails showed yellowish discoloration along with thickening and excessive curving of the finger nails (Fig. 1), which had not responded to antifungals. A chest X-ray and computed tomography scan of the chest showed bilateral moderate pleural effusions. Thoracocentesis revealed an exudative pleural fluid with lymphocytic predominance.

Fig. 1 Yellow, thickened and curved nails with pitting edema in both lower legs.

Yellow nail syndrome is a clinical triad consisting of yellowed/thickened nails, lymphedema and recurring respiratory symptoms. Structural or functional lymphatic abnormalities and increased vascular permeability to albumin are proposed pathologic mechanisms. The syndrome is linked to a variety of underlying diseases, including rheumatoid arthritis, malignancy, immuno-deficiency and endocrine disorders. The syndrome is characterized by remissions and relapses. Management is primarily supportive and palliative.