Diffuse centrilobular nodular opacities in yellow nail syndrome.

Area of Science:

• Pulmonology
• Genetics
• Internal Medicine

Background:

• Diffuse panbronchiolitis (DPB) is a chronic airway inflammation often treated with macrolides.
• Yellow nail syndrome (YNS) is a rare disorder characterized by yellowing of the nails, lymphedema, and respiratory issues.
• Centrilobular opacities on chest CT can be indicative of various lung diseases, including DPB.

Purpose of the Study:

• To report a case of YNS initially misdiagnosed as DPB.
• To investigate the potential role of lymphatic dysfunction in YNS-related centrilobular opacities.
• To emphasize the importance of considering YNS in patients with unexplained centrilobular opacities.

Main Methods:

• Case report of a Japanese woman in her 70s.
• Clinical presentation, chest CT findings, and microbiological data were analyzed.
• Diagnostic re-evaluation after 6 years of initial presentation.

Main Results:

• Initial diagnosis of DPB based on cough, sputum, Pseudomonas aeruginosa, and centrilobular opacities.
• Ineffective macrolide therapy and progressive opacities.
• Development of yellow nails led to revised diagnosis of YNS.

Conclusions:

• YNS can present with centrilobular opacities that mimic DPB.
• Lymphatic dysfunction in YNS may contribute to the formation of centrilobular opacities.
• Early recognition of YNS is crucial for appropriate management.