Diffuse centrilobular nodular opacities in yellow nail syndrome

This case report describes a Japanese woman in her 70s who was initially diagnosed with diffuse panbronchiolitis (DPB) and treated with long-term macrolide therapy. The patient presented with a persistent cough and purulent sputum, and a CT of the chest showed centrilobular opacities. The clinical course, which included the detection of Pseudomonas aeruginosa and obstructive impairment, was consistent with DPB. However, the treatment was ineffective, and the opacities worsened over time. Subsequently, 6 years after the initial presentation, yellow nails were observed, leading to a revised diagnosis of yellow nail syndrome (YNS). This noteworthy case, presenting with centrilobular opacities closely resembling DPB, is an important example suggesting that lymphatic dysfunction in YNS may be involved in the formation of centrilobular opacities.