EC Pulmonology and Respiratory Medicine

We report the case of a 64-year-old man with diabetes mellitus who developed progressive dyspnoea, recurrent bilateral pleural effusions, and chronic lower-limb oedema with recurrent cellulitis over 15 years. Imaging revealed bilateral pleural effusions with right-sided bronchiectasis, and skin biopsy showed tissue oedema with dilated lymphatic channels. The combination of persistent pleuropulmonary disease and lymphedema, along with classical nail changes, strongly suggested the possibility of Yellow Nail Syndrome with secondary elephantiasis nostras verrucosa. The patient partly improved with targeted antimicrobial therapy, anticoagulation, and supportive care. There was no definite association of yellow nail syndrome with elephantiasis nostras verrucosa reported in the literature. But chronic lymphatic malformation and lymph edema were considered risk factors for elephantiasis nostras verrucosa. This case underscores the need to consider lymphatic disorders in adults with recurrent pleural effusions and chronic lower-limb changes, even when nail abnormalities were subtle.

 Keywords: Elephantiasis Nostras Verrucosa; Yellow Nail Syndrome; Lymphedema; Pleural Effusion

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