Yellow Nail Syndrome and Pulmonary Fibrosis Overview

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Yellow Nail Syndrome

• Characteristics: Nails appear yellow, thickened, and curved. Nails may stop growing and can detach from the nail bed.
• Triad of Symptoms:
  • Yellow discoloration of the nails
  • Lymphedema
  • Pleural effusions
• Associated Findings: Bronchiectasis occurs in about 40% of cases.

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Lung Fibrosis Overview

Fibrosis Predominantly Affecting the Upper Zones

• Extrinsic Allergic Alveolitis (EAA)
• Coal Worker’s Pneumoconiosis / Progressive Massive Fibrosis
• Tuberculosis
• Sarcoidosis
• Histiocytosis
• Silicosis
• Ankylosing Spondylitis (rare)
• Radiation

Fibrosis Predominantly Affecting the Lower Zones

• Cryptogenic Fibrosing Alveolitis (IPF)
• Drug-induced
• Asbestosis
• Most connective tissue disorders (except ankylosing spondylitis)

Note: More common causes (like cryptogenic fibrosing alveolitis) typically affect the lower zones.

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Histiocytosis X

Diagnosis: Pentalaminar X bodies (Birbeck granules) found on bronchoalveolar lavage (BAL) are diagnostic.

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Drug-Induced Pulmonary Fibrosis

Common Drugs

• Cytotoxics:
  • Busulfan
  • Methotrexate
  • Cyclophosphamide
  • Bleomycin
• Antibiotics:
  • Nitrofurantoin
• Cardiac Drugs:
  • Amiodarone
  • Hydralazine
  • Tocainide
• Opiates: Heroin abuse
• Others:
  • Sulphasalazine (rare pulmonary toxicity)
  • Gold
  • Dosulepin (Prothiadine®)

Treatment

• Drug withdrawal and/or corticosteroids.
• Penicillamine can be considered for treatment.