Xanthoma disseminatum (XD) is a rare and benign proliferative systemic disease that usually affects the skin and mucosal membranes with variable extent. Extensive systemic involvement can be associated with higher morbidity. There is paucity in the literature describing this rare pathological entity, and the ideal management remains controversial. In this article, we report our experience with cladribine in treating a case of XD. We documented the clinical and pathological manifestations of a 24-year-old woman who was initially diagnosed with rheumatoid arthritis. She presented to our institute with respiratory compromise and was found to have XD affecting skin, mucosal membranes, joints, and bone marrow. The patient received six cycles of cladribine for 6 months, during which she showed a remarkable response in relation to the respiratory lesions. Her hemoglobin also normalized and inflammatory markers gradually decreased to reach normal values. However, her skin lesions did not respond to treatment but no new lesions appeared. With our experience with cladribine, we believe that it could be a promising treatment option for XD. However, more work has to be conducted to determine the efficacy and safety in the long term. Key message: Given the rarity of this understudied entity, the natural history and the ultimate treatment remain unclear. We highlight the natural history and clinical course of xanthoma disseminatum (XD) in this article. We also describe our experience with cladribine in treating XD. We believe that similar experiences should be compiled to better understand this pathology and the effective therapy options for these patients.

Yellow nail syndrome (YNS) is a rare disorder initially described in 1964. It is characterized by a classical triad: yellow nails, lymphedema, and respiratory manifestations. We present a 71-year-old woman who presented with progressive dyspnea. Medical history includes hypertension treated with amlodipine. Examination showed bilateral lower extremity non-pitting edema, yellowish discoloration of nails, and bilateral pleural effusion. Thoracentesis demonstrated chylous effusion. The presumptive diagnosis was YNS. Assuming amlodipine as a cause of interstitial edema, it was stopped, and the symptoms improved gradually. After two months, amlodipine was restarted externally, and the dyspnea relapsed. Amlodipine was discontinued again. After two years of amlodipine cessation, the patient remained well without symptoms. The progression and resolution of symptoms point to amlodipine as a suggested cause of YNS. Paying attention to the prescribed drugs was the key to diagnosing and resolving serious complications.