{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T05:21:30Z","timestamp":1761888090757,"version":"build-2065373602"},"reference-count":26,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T00:00:00Z","timestamp":1761782400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Reports"],"abstract":"<jats:p>Background and clinical significance: Lymphedema is a relatively common clinical manifestation in patients and has a broad differential diagnosis, the main concern being the exclusion of malignancy. However, a rare constellation of lymphedema with systemic features and no underlying malignancy is yellow nail syndrome (YNS). YNS is a lymphatic abnormality, characterized by a triad of yellow nails, primary lymphedema and respiratory manifestations. Case presentation: Here, we report a 74-year-old male patient who presented to us with massive chylous ascites, cough, yellow nails and recurrent bilateral leg edema. During the last 10 years, he had thrice undergone thoracocentesis, which revealed chylous pleural effusion, although there was no documented diagnosis of yellow nail syndrome. We pursued a thorough work-up to rule out underlying cirrhosis and malignancy (the main causes of chylous ascites). There are only few cases of yellow nail syndrome reported in the literature with chylous ascites as a manifestation of YNS. Conclusions: The co-existence of chylous ascites with the classical triad of pleural effusion, lymphedema and yellow nail changes in the same patient has to be included in the diagnostic process to differentiate this entity from liver cirrhosis and solid or hematological cancer.<\/jats:p>","DOI":"10.3390\/reports8040219","type":"journal-article","created":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T02:48:28Z","timestamp":1761878908000},"page":"219","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A 74-Year-Old Man with Massive Ascites: A Case Report of Yellow Nail Syndrome"],"prefix":"10.3390","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-6458-8201","authenticated-orcid":false,"given":"Iliana","family":"Stamatiou","sequence":"first","affiliation":[{"name":"Second University Department of Internal Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-0212-9398","authenticated-orcid":false,"given":"Melina","family":"Ntoga","sequence":"additional","affiliation":[{"name":"Second University Department of Internal Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christos","family":"Karagiannis","sequence":"additional","affiliation":[{"name":"Second University Department of Internal Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pipitsa N.","family":"Valsamaki","sequence":"additional","affiliation":[{"name":"Nuclear Medicine Department, Democritus University of Thrace, 68100 Alexandroupolis, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4846-2178","authenticated-orcid":false,"given":"Dimitrios","family":"Papazoglou","sequence":"additional","affiliation":[{"name":"Second University Department of Internal Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Petros","family":"Rafailidis","sequence":"additional","affiliation":[{"name":"Second University Department of Internal Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1186\/s13023-017-0594-4","article-title":"Yellow nail syndrome: A review","volume":"12","author":"Vignes","year":"2017","journal-title":"Orphanet J. Rare Dis."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1378\/chest.08-0137","article-title":"Yellow nail syndrome: Analysis of 41 consecutive patients","volume":"134","author":"Maldonado","year":"2008","journal-title":"Chest"},{"key":"ref_3","first-page":"393","article-title":"Ascites and spontaneous bacterial peritonitis","volume":"Volume 1","author":"Schiff","year":"2012","journal-title":"Schiff\u2019s Diseases of the Liver"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"438","DOI":"10.4297\/najms.2011.3438","article-title":"Chylous ascites","volume":"3","author":"Talluri","year":"2011","journal-title":"N. Am. J. Med. Sci."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1266","DOI":"10.1136\/gut.26.11.1266","article-title":"Chylous ascites, intestinal lymphangiectasia and the \u2018yellow-nail\u2019 syndrome","volume":"26","author":"Duhra","year":"1985","journal-title":"Gut"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1016\/S0248-8663(88)80147-4","article-title":"Yellow nail syndrome with chylous effusions","volume":"9","author":"Valmary","year":"1988","journal-title":"Rev. Med. Interne"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1622","DOI":"10.1136\/gut.30.11.1622","article-title":"Dietary treatment of chylous ascites in yellow nail syndrome","volume":"30","author":"Tan","year":"1989","journal-title":"Gut"},{"key":"ref_8","first-page":"763","article-title":"A case of the yellow nail syndrome associated with massive chylous ascites, pleural and pericardial effusions","volume":"34","author":"Malek","year":"1996","journal-title":"Z. Gastroenterol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1017","DOI":"10.1016\/S0016-5085(99)70097-1","article-title":"Octreotide for therapy of chylous ascites in yellow nail syndrome","volume":"116","author":"Widjaja","year":"1999","journal-title":"Gastroenterology"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"906","DOI":"10.1111\/j.1399-3046.2008.00955.x","article-title":"Successful living-related liver transplantation in a child with familial yellow nail syndrome and fulminant hepatic failure: Report of a case","volume":"12","author":"Kansu","year":"2008","journal-title":"Pediatr. Transplant."},{"key":"ref_11","first-page":"155","article-title":"Management of incarcerated inguinal hernia in a patient with yellow nail syndrome","volume":"49","author":"Omari","year":"2008","journal-title":"Singap. Med. J."},{"key":"ref_12","first-page":"176","article-title":"Yellow nail syndrome as a cause of unexplained edema","volume":"71","author":"Cimini","year":"2009","journal-title":"Monaldi Arch. Chest Dis."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e235273","DOI":"10.1136\/bcr-2020-235273","article-title":"Unusual presentation of a man with recurrent chylous ascites","volume":"14","author":"Joshi","year":"2021","journal-title":"BMJ Case Rep."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1111\/j.1524-4725.1978.tb00422.x","article-title":"Pigmentations of the nails (chromonychia)","volume":"4","author":"Baran","year":"1978","journal-title":"J. Dermatol. Surg. Oncol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"792","DOI":"10.1016\/S0190-9622(09)80277-6","article-title":"Yellow nail syndrome in a patient with mycosis fungoides","volume":"28","author":"Stosiek","year":"1993","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1093\/omcr\/omw013","article-title":"Yellow nail syndrome in rheumatoid arthritis: An aetiology beyond thiol drugs","volume":"2016","author":"Mishra","year":"2016","journal-title":"Oxf. Med. Case Rep."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1111\/j.0954-6820.1986.tb03302.x","article-title":"Yellow nail syndrome\u2014The triad of yellow nails, lymphoedema, and pleural effusions. A review of the literature and a case report","volume":"219","author":"Nordkild","year":"1986","journal-title":"Acta Med. Scand."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"985","DOI":"10.1111\/resp.12357","article-title":"Characteristics of patients with yellow nail syndrome and pleural effusion","volume":"19","author":"Huggins","year":"2014","journal-title":"Respirology"},{"key":"ref_19","first-page":"821","article-title":"Pleural-fluid kinetics in a patient with primary lymphedema, pleural effusions, and yellow nails","volume":"119","author":"Runyon","year":"1979","journal-title":"Am. Rev. Respir. Dis."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1097\/MCP.0b013e32832ad45a","article-title":"Yellow nail syndrome","volume":"15","author":"Maldonado","year":"2009","journal-title":"Curr. Opin. Pulm. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1177\/1358836X9800300209","article-title":"Lymphedema: Classification, diagnosis and therapy","volume":"3","author":"Szuba","year":"1998","journal-title":"Vasc. Med."},{"key":"ref_22","first-page":"276","article-title":"Combination of fluconazole and alpha-tocopherol in the treatment of yellow nail syndrome","volume":"8","author":"Baran","year":"2009","journal-title":"J. Drugs Dermatol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e497","DOI":"10.1111\/ijd.12916","article-title":"Dramatic improvement of yellow nail syndrome with a combination of intralesional triamcinolone, fluconazole, and sinusitis management","volume":"54","author":"Imadojemu","year":"2015","journal-title":"Int. J. Dermatol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1111\/j.1752-699X.2007.00022.x","article-title":"Yellow nail syndrome: Treatment with octreotide","volume":"1","author":"Hillerdal","year":"2007","journal-title":"Clin. Respir. J."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"246","DOI":"10.7326\/0003-4819-141-3-200408030-00028","article-title":"Successful octreotide treatment of chylous pleural effusion and lymphedema in the yellow nail syndrome","volume":"141","author":"Makrilakis","year":"2004","journal-title":"Ann. Intern. Med."},{"key":"ref_26","unstructured":"International Society of Lymphology (2013). The diagnosis and treatment of peripheral lymphedema: 2013 consensus document of the International Society of Lymphology. Lymphology, 46, 1\u201311."}],"container-title":["Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2571-841X\/8\/4\/219\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T03:41:07Z","timestamp":1761882067000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2571-841X\/8\/4\/219"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,30]]},"references-count":26,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["reports8040219"],"URL":"https:\/\/doi.org\/10.3390\/reports8040219","relation":{},"ISSN":["2571-841X"],"issn-type":[{"value":"2571-841X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,30]]}}}