# A 74-Year-Old Man with Massive Ascites: A Case Report of Yellow Nail Syndrome

## TL;DR

A 74-year-old man with yellow nails, leg swelling, and chylous ascites is reported as a rare case of yellow nail syndrome.

## Contribution

This case highlights the rare association of chylous ascites with yellow nail syndrome, expanding its clinical recognition.

## Key findings

- The patient exhibited yellow nails, lymphedema, and chylous ascites, consistent with yellow nail syndrome.
- Thoracocentesis revealed chylous pleural effusion, a rare manifestation of YNS.
- The case emphasizes the need to consider YNS in patients with chylous ascites to avoid misdiagnosis.

## Abstract

Background and clinical significance: Lymphedema is a relatively common clinical manifestation in patients and has a broad differential diagnosis, the main concern being the exclusion of malignancy. However, a rare constellation of lymphedema with systemic features and no underlying malignancy is yellow nail syndrome (YNS). YNS is a lymphatic abnormality, characterized by a triad of yellow nails, primary lymphedema and respiratory manifestations. Case presentation: Here, we report a 74-year-old male patient who presented to us with massive chylous ascites, cough, yellow nails and recurrent bilateral leg edema. During the last 10 years, he had thrice undergone thoracocentesis, which revealed chylous pleural effusion, although there was no documented diagnosis of yellow nail syndrome. We pursued a thorough work-up to rule out underlying cirrhosis and malignancy (the main causes of chylous ascites). There are only few cases of yellow nail syndrome reported in the literature with chylous ascites as a manifestation of YNS. Conclusions: The co-existence of chylous ascites with the classical triad of pleural effusion, lymphedema and yellow nail changes in the same patient has to be included in the diagnostic process to differentiate this entity from liver cirrhosis and solid or hematological cancer.