Dyspnoea, cough, edema: Heart failure or what else?

Luca Morolli, Davide Lazzarini, Giuseppa Micali, Giorgio Ioli

Third Department of Internal Medicine, Azienda Unita Sanitaria Locale di Rimini, Rimini, Italy.

DOI: 10.4236/health.2012.46052                

Abstract

We present the case of a 55-year-old man admitted for dyspnea, cough and edema of the legs and feet. The patient, a smoker with psoriasis at hands and feet noted the comparison, three years ago, of marked thickening and yellow discoloration of the nails. The chest X-ray showed a right-sided pleural effusion with parenchymal atelectasis. The cytologic examination of pleural fluid revealed mesothelial cells with inflammatory changes. The bacterial culture of the pleural fluid was negative and pleural biopsies revealed fibrosis. To reduce dyspnoea and formation of pleural fluid, was performed a pleurodesis by talcage. The patient was discharged with itraconazole, high dose vitamin E and zinc supplements as home therapy. The correct diagnosis was not easily achieved because the patient had symptoms and signs referable to other diseases as heart failure or venous insufficiency or psoriasis.

Keywords

Samman-Emerson Syndrome; Yellow Nail Syndrome; Limphedema; Pleural Effusion

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Samman, P.D. and White, W.F. (1964) The “yellow nail” syndrome. British Journal of Dermatology, 76, 153-157. doi:10.1111/j.1365-2133.1964.tb14499.x
[2]	Emerson, P.A. (1966) Yellow nails, lymphedema and pleural effusion. Thorax, 21, 247-253. doi:10.1136/thx.21.3.247
[3]	Razi, E. (2006) Familial yellow nail syndrome. Dermatology Online Journal, 12, 15.
[4]	Nanda, S., et al. (2009) Yellow nail syndrome. Canadian Medical Association Journal, 181, 614. doi:10.1503/cmaj.080255
[5]	Tosti, A., et al. (2002) Systemic itraconazole in the yellow nail syndrome. British Journal of Dermatology, 146, 1064-1067. doi:10.1046/j.1365-2133.2002.04671.x
[6]	Maldonado, F., et al. (2009) Yellow nail syndrome. Current Opinion in Pulmonary Medicine, 15, 371-375. doi:10.1097/MCP.0b013e32832ad45a
[7]	Hiller, E., et al. (1972) Pulmonary manifestations of the yellow nail syndrome. Chest, 61, 452-458. doi:10.1378/chest.61.5.452
[8]	Hershko, A., et al. (1997) Yellow nail syndrome. Postgraduate Medical Journal, 73, 466-468. doi:10.1136/pgmj.73.862.466
[9]	Thomas, P.S., et al. (1987) Yellow nail syndrome and bronchial carcinoma [letter]. Chest, 92, 191. doi:10.1378/chest.92.1.191a
[10]	Makrilakis, K., et al. (2004) Successful octreotide treatment of chylous pleural effusion and lymphedema in the yellow nail syndrome. Annals of Internal Medicine, 141, 246-247.
[11]	Maldonado, F., et al. (2008) Yellow nail syndrome: Analysis of 41 consecutive patients. Chest, 134, 375-381. doi:10.1378/chest.08-0137