The yellow brick road

Yellow nail syndrome is an uncommon condition characterized by dystrophic yellow nails, lymphedema and respiratory tract involvement. This syndrome typically shows up in middle-aged patients. Although several etiologies have been described, to date, the exact underlying mechanism remains unclear. The most supported pathogenetic hypothesis argues that it results from an abnormal lymphatic drainage. Hereby, we describe the associations of yellow nail syndrome typical features in a 73-year-old man with an acute onset of symptoms. He was admitted to our hospital with acute respiratory failure requiring non-invasive ventilation. Despite our advice, he rapidly relapsed. Taking care of his multiple comorbidities — cardiomyopathy, sleep apnea syndrome and severe obstructive deficit — his symptoms finally improved. Adherence to nocturnal non-invasive ventilation, bronchodilator therapy and pulmonary rehabilitation provided him stability. Acute and critical presentation could mystify the diagnosis of rare syndromes such as the yellow nail syndrome. Its precocious recognition reinforced our approach justifying a detailed screening of the patient’s conditions.