Chronic Large Pericardial Effusion Due to Rare Yellow Nail Syndrome

Yellow nail syndrome (YNS) is a rare disorder characterized by the triad of yellow nails, lymphedema, and respiratory manifestations. Rarely, pericardial effusion can occur and guidance on management is limited.

A 71-year-old man presented with chronic large pericardial and pleural effusions, lower extremity lymphedema, and yellow nail discoloration. He was diagnosed with YNS, and several years later hypothyroidism was identified. Treatment with thyroid hormone led to improvement in his pericardial effusion and stabilization of pleural effusions.

Pericardial involvement in YNS is rare, but can manifest as large effusions. In such cases, it is important to exclude concomitant reversible conditions such as hypothyroidism or autoimmune disease. This case suggests a common pathway between hypothyroidism and YNS pathophysiology with improvement after treatment, but not complete resolution. Chronic, large pericardial effusions in hemodynamically stable patients can safely be monitored with surveillance.