A Case of Yellow Nail Syndrome with Dramatically Improved Nail Discoloration by Oral Clarithromycin

Abstract

An 80-year-old woman was admitted to our hospital with pneumonia and exacerbation of sinobronchial syndrome (SBS). She presented with yellow discoloration of the nail beds of all fingers and toes, and her nails were recognized as growing slowly. Chest X-ray revealed bronchiectasis in the bilateral lower lobe and bilateral pleural effusion. We diagnosed her as having yellow nail syndrome (YNS), based on the triad of yellow nails, lymphedema, and lung disease. After treatment with antibiotics [ampicillin/sulbactam and clarithromycin (CAM)] for pneumonia and SBS, her general condition improved, and the yellow nails disappeared in some fingers. When she was previously treated with 200 mg CAM for SBS, her yellow nails had not shown improvement. This time, her yellow nails improved after treatment with 400 mg CAM. The literature reports vitamin E, zinc, and topical corticosteroid plus active vitamin D3 to be effective in the treatment of yellow nails. Two studies have reported treatment for YNS using CAM, though they found a lack of efficacy. Thus, the present case is the first to report improved yellow nails using CAM alone. We conclude that not only SBS and lung disease but also YNS were improved by treatment with 400 mg CAM.

Bronchiectasis in yellow nail syndrome

“…Improvement with clarithromycin has been described in two case studies of YNS. 33,34 However, one study focused on nail improvement, whilst the second described a case of eosinophilic bronchial disease in YNS, unlike in our cohort.…”

Relapse of Yellow Nail Syndrome with Pulmonary Lymphedema

“…Another report showed that clarithromycin treatment for lung diseases ended in the complete resolution of yellow nails (3). Similarly, in the present case, oral prednisolone therapy for the patient's lung involvement was considered to be responsible for the normalization of his nail color; however, the precise extent and impact of prednisolone therapy on the progression of YNS are unknown, particularly in the context of lung involvement.…”

Yellow nail syndrome: a case report and review of treatment options

“…Treatment decisions are typically based on anecdotal evidence, case reports and intuition. Treatment is predominantly supportive, but it should be noted that successful treatment of one component of the triad often causes symptomatic improvement in the others .…”