Mallah Shatha, Mallah Haneen, Owda Fahed, Gomez-Manjarres Diana, Peruvemba Sriram
Internal Medicine, An-Najah National University, Nablus, PSE.
Pulmonary and Critical Care Medicine, University of Florida Health, Gainesville, USA.
Cureus. 2025 Apr 7;17(4):e81841. doi: 10.7759/cureus.81841. eCollection 2025 Apr.
Yellow nail syndrome (YNS) is a rare disorder marked by a triad of symptoms: lymphedema, yellow discolored nails, and respiratory manifestations. It is often associated with conditions such as chronic cough, bronchiectasis, pleural effusion, and chronic rhinosinusitis. Although its precise etiology remains elusive, it is believed that impaired lymphatic drainage plays a central role in its pathogenesis. YNS predominantly affects individuals over the age of 50, and there is no definitive treatment, though some cases may achieve partial or spontaneous remission. In this report, we present the case of a man in his mid-30s with a one-year history of persistent cough, sinus congestion, yellow deformed nails, and lymphedema. Extensive investigations, including imaging and pulmonary function tests, revealed no significant pulmonary abnormalities. The patient underwent multiple rounds of treatments, including antibiotics, antifungal therapy, inhaled and systemic corticosteroids, and nail care regimens, all of which proved ineffective in resolving his symptoms. Further evaluation, including dental imaging, uncovered an odontogenic abscess. After the infected tooth was extracted, the patient experienced a significant and gradual resolution of his symptoms, including yellow nail discoloration and sinus issues. This case highlights the importance of considering secondary causes, such as dental infections, in the workup of patients with YNS, particularly when standard treatments fail to produce improvements. To our knowledge, this is the first reported case identifying a tooth abscess as the potential cause of YNS. YNS has been linked to several systemic conditions, including autoimmune disorders, thyroid dysfunction, nephrotic syndrome, and malignancies, but an association with dental abscesses has not been previously documented. This case underscores the critical need for a thorough evaluation of potential contributory factors in YNS, especially in younger patients who do not fit the typical demographic profile. It also emphasizes the importance of timely management of secondary infections, which can lead to significant clinical improvement in such cases. By illustrating a rare presentation of YNS, this case provides further insight into the syndrome's complexity and the potential role of odontogenic infections in its development.
黄甲综合征（YNS）是一种罕见的疾病，其特征为三联征症状：淋巴水肿、指甲变黄和呼吸道表现。它常与慢性咳嗽、支气管扩张、胸腔积液和慢性鼻窦炎等病症相关。尽管其确切病因尚不清楚，但据信淋巴引流受损在其发病机制中起核心作用。YNS主要影响50岁以上的人群，且没有明确的治疗方法，不过一些病例可能会部分缓解或自发缓解。在本报告中，我们介绍了一名35岁左右的男性病例，他有持续咳嗽、鼻窦充血、指甲变黄变形和淋巴水肿的病史一年。包括影像学和肺功能测试在内的广泛检查未发现明显的肺部异常。该患者接受了多轮治疗，包括抗生素、抗真菌治疗、吸入和全身性皮质类固醇以及指甲护理方案，但所有这些治疗均未能有效缓解他的症状。进一步评估，包括牙科影像学检查，发现了牙源性脓肿。拔除感染牙齿后，患者的症状，包括指甲变黄和鼻窦问题，得到了显著且逐渐的缓解。该病例强调了在YNS患者的检查中考虑继发性病因（如牙科感染）的重要性，特别是在标准治疗未能产生改善效果时。据我们所知，这是第一例报告的将牙脓肿确定为YNS潜在病因的病例。YNS与多种全身性疾病有关，包括自身免疫性疾病、甲状腺功能障碍、肾病综合征和恶性肿瘤，但此前尚未记录到与牙脓肿的关联。该病例强调了对YNS潜在促成因素进行全面评估的迫切需求，特别是在不符合典型人口统计学特征的年轻患者中。它还强调了及时处理继发性感染的重要性，这可导致此类病例的显著临床改善。通过说明YNS的一种罕见表现，该病例进一步深入了解了该综合征的复杂性以及牙源性感染在其发展中的潜在作用。
