A 93-year-old lady presented following a fall causing pubic rami fractures. Clinical examination revealed yellow discolouration of the nails (Figure 1a), which had been observed for two years previous. CT chest imaging obtained during a prior admission for pneumonia demonstrated bilateral pleural effusions (Figure 1b).
Yellow nail syndrome describes the rare triad of slow-growing, thickened, yellow nails; lymphoedema and respiratory manifestations. Clinical diagnosis can be made if two features are present, not necessarily concurrently. Lymphoedema is known to manifest years after nail changes appear [1]. Respiratory involvement is often chronic and includes pleural effusion (usually exudative), bronchiectasis, sinusitis and pneumonia [1-3].