Idiopathic Yellow Nail Syndrome Successfully Treated with OK-432

Yamagishi, Toshiyuki; Hatanaka, Nobuyuki; Kamemura, Hirotaka; Nakazawa, Ichiro; Hirano, Yusuke; Kodaka, Norio; Miura, Atsuo; Kitahara, Ayao; Sawata, Tetsuro; Hosaka, Kimio; Sanno, Ken

doi:10.2169/internalmedicine.46.0022

Cited by 18 publications

(15 citation statements)

References 9 publications

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“…The mechanism of lymphopaenia and immunodeficiency in YNS remains to be defined. It is possible that peripheral blood lymphopaenia is because of migration of lymphocytes in lymphoedematous tissue/fluid, which would be consistent with the large number of lymphocytes in pleural fluid in our patient and reported lymphocytic infiltration in dermis biopsied from oedematous area in the extremity [5]. Moldanado et al.…”

Section: Discussionsupporting

confidence: 81%

“…A 68‐year‐old man presented with a history of chronic cough with productive sputum of 2–3 years duration, was diagnosed with bronchiectasis, and was also found to have pleural effusion requiring recurrent drainage and pleurodesis, including with K‐432 with minimal beneficial effect. K‐432 is a haemolytic streptococcal preparation that has been treated with penicillin [5]. He also developed bilateral leg and foot swellings at the time of initial symptoms, for which he was placed on diuretics with minimal response.…”

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confidence: 99%

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T and B Cell Deficiency Associated with Yellow Nail Syndrome

et al. 2012

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Yellow nail syndrome (YNS) is a rare disorder of unknown aetiology that is characterized by yellow nails associated with lymphoedema and chronic respiratory manifestations. There are no detailed immunological studies in YNS. In this study, we present first extensive immunological analysis of both adaptive and innate immunity in two patients with YNS. One patient has common variable immunodeficiency, whereas second patient has specific antibody deficiency syndrome. Severe lymphopaenia, a striking deficiency of naïve CD4+ and CD8+ T cells and total B cells, and increased transitional B cells were observed. T cell proliferative response to mitogens and antigens was significantly reduced in both patients. Both patients failed to make specific antibody response to pneumococci. Complement, natural killer cell activity and neutrophil oxidative burst were normal. Immunoglobulin administration resulted in decreased frequency and severity of infections, and an impressive effect was observed on lymphoedema and on the recurrence of pleural effusion. Our data show that YNS is associated with both T and B cell defects. Furthermore, Immunoglobulin may be beneficial in clinical manifestations of lymphoedema.

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Section: Discussionsupporting

confidence: 81%

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confidence: 99%

T and B Cell Deficiency Associated with Yellow Nail Syndrome

et al. 2012

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“…Only one patient reportedly experienced a period of four years stability with later recurrence of a symptomatic PE. 112 A total of 81.8% patients treated with pleurodesis (27/32) progressed favourably (partial or complete), 1,2,9,30,41,42,44,54,59,65,[71][72][73]75,76,[81][82][83]92,98,101,103,104,112,118,119 while six patients had a poor outcome. 9,40,51,84,108 Another technique with a generally favourable response was decortication/pleurectomy (8 patients; 2,8,19,21,28,58,98,110 89%), although not in all cases.…”

Section: Discussionmentioning

confidence: 99%

Characteristics of patients with yellow nail syndrome and pleural effusion

et al. 2014

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Yellow nail syndrome (YNS) can be associated with a pleural effusion (PE) but the characteristics of these patients are not well defined. We performed a systematic review across four electronic databases for studies reporting clinical findings, PE characteristics, and most effective treatment of YNS. Case descriptions and retrospective studies were included, unrestricted by year of publication. We reviewed 112 studies (150 patients), spanning a period of nearly 50 years. The male/female ratio was 1.2/1. The median age was 60 years (range: 0-88). Seventy-eight percent were between 41-80 years old. All cases had lymphoedema and 85.6% had yellow nails. PEs were bilateral in 68.3%. The appearance of the fluid was serous in 75.3%, milky in 22.3% and purulent in 3.5%. The PE was an exudate in 94.7% with lymphocytic predominance in 96% with a low count of nucleated cells. In 61 of 66 (92.4%) of patients, pleural fluid protein values were >3 g/dL, and typically higher than pleural fluid LDH. Pleurodesis and decortication/pleurectomy were effective in 81.8% and 88.9% of cases, respectively, in the treatment of symptomatic PEs. The development of YNS and PE occurs between the fifth to eighth decade of life and is associated with lymphoedema. The PE is usually bilateral and behaves as a lymphocyte-predominant exudate. The most effective treatments appear to be pleurodesis and decortication/pleurectomy.

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“…The greatest clinical concerns are however related to recurrent pleural effusions, as pleural cavity drainage gives only short‐term improvement in most cases; pleurodesis appears to be more effective. Some authors successfully administered bleomycin, tetracycline and OK‐432 . Pleuro‐peritoneal shunts can be implanted, with alternative shunts between the venous system and the pleural or peritoneal cavity .…”

Section: Discussionmentioning

confidence: 99%

Yellow nail syndrome presenting with postpartum massive pleural effusion

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et al. 2014

Clinical Respiratory J

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Yellow nail syndrome (YNS) is an uncommon clinical syndrome characterized by yellow-green discoloration of nails and recurrent respiratory tract lesions, pleural effusions and lymphedema. A 38-year-old woman was referred to the emergency complaining of chronic cough and increasing dyspnea within last 2 weeks. She had given birth 1 month ago. On examination, the patient exhibited dystrophic yellowish nails and mild peripheral lymphedema. A chest roentgenogram revealed a large right pleural effusion and a small left pleural effusion. YNS is a rare clinical entity but should be taken into consideration in patients with massive pleural effusions and persistent lymphedemas on the postpartum period.

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Idiopathic Yellow Nail Syndrome Successfully Treated with OK-432

Abstract: Abstract

Cited by 18 publications

References 9 publications

T and B Cell Deficiency Associated with Yellow Nail Syndrome

T and B Cell Deficiency Associated with Yellow Nail Syndrome

Characteristics of patients with yellow nail syndrome and pleural effusion

Yellow nail syndrome presenting with postpartum massive pleural effusion

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