Yellow Nail Syndrome with Bilateral Pleural Plaques and Diffuse Pleural Thickening: A Mimic of Asbestos Related Disease

Our plain-English summary of Yellow Nail Syndrome with Bilateral Pleural Plaques and Diffuse Pleural Thickening: A Mimic of Asbestos Related Disease, by A. Dallmann, R.L. Attanoos (Case Reports in Pulmonology, 2018).

The study

• Authors: A. Dallmann, R.L. Attanoos
• Journal: Case Reports in Pulmonology
• Published: 2018;2018:7302898
• Type of article: Case report
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Yellow nail syndrome is a rare acquired condition of unknown aetiology associated with distinct nail discolouration/xanthonychia, pulmonary manifestations, and lymphoedema. Pleural plaques and diffuse pleural thickening are typically, although not exclusively, recognised as markers of prior commercial asbestos exposure. The presence of such biomarkers may assist an asbestos personal injury evaluation. A postmortem examination performed on a 72-year-old man with known long-standing yellow nail syndrome identified pleural plaques and diffuse pleural thickening. An evaluation of the occupational history identified no known asbestos exposure. Electron microscopic mineral fibre analysis detected no asbestos fibres. To the best of our knowledge, this is the only case of yellow nail syndrome in which these benign pleural changes are reported ex asbestos. Alternate causes for such pleural pathology were absent. There is merit in physicians and pathologists having an awareness of these new manifestations when considering claimed asbestos related changes during life and at postmortem.

In plain English

This case report described a man diagnosed with yellow nail syndrome in 2000, at age 62. The condition is associated with nail discolouration, leg swelling and lung problems. He had recurrent pleural effusions (fluid around the lungs) and bronchiectasis, and died in 2010. His recorded cause of death was yellow nail syndrome complicated by lobar pneumonia and diffuse pleural fibrosis, listed as the immediate cause. He had smoked heavily and worked as a general manager, policeman, clothing design director and dark room technician. Evaluation found no known occupational asbestos exposure. At postmortem, microscopy confirmed bilateral parietal pleural plaques and diffuse visceral pleural thickening. Light microscopy found no asbestos bodies, and electron microscope analysis of the left lung found no amphibole asbestos fibres and no chrysotile. The analysis also detected fibrous mullite, fibrous silica, muscovite, talc and low-level titanium. Talc had earlier been placed in his right pleural space as treatment (talc pleurodesis). The authors concluded that yellow nail syndrome may cause diffuse pleural fibrosis and pleural plaques without a history of asbestos exposure. They said doctors and pathologists assessing claimed asbestos-related disease should know this.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (one patient, including postmortem examination and lung mineral fibre analysis)
• Who was studied: one man diagnosed with yellow nail syndrome in 2000 at age 62, who died in 2010 and was examined at postmortem
• Exposure: no known asbestos exposure; jobs were general manager, policeman, clothing design director and dark room technician; heavy tobacco smoking; talc pleurodesis in the right pleural space
• Main results:
  • At postmortem the man had extensive bilateral pleural adhesions, diffuse visceral pleural thickening and parietal pleural plaques
  • Microscopy confirmed hyaline collagen plaques with a basket-weave pattern and bilateral diffuse pleural fibrosis
  • Light microscopy of multiple lung sections found no asbestos bodies
  • Transmission electron microscopy of left lung tissue found no commercial or noncommercial amphibole asbestos fibres and no chrysotile asbestos
  • Fibrous mullite (a non-asbestos aluminium silicate), fibrous silica and muscovite were detected, which the authors said confirmed the analysis worked
  • Non-fibrous mineral analysis detected silicon, talc, aluminium, titanium and iron; the authors said the significance of the low-level titanium on its own was uncertain
  • There was a talc pleurodesis reaction in the right pleural space, and talc particles were seen in lung tissue on both sides
  • Cause of death was recorded as yellow nail syndrome complicated by infection (lobar pneumonia) and diffuse pleural fibrosis, with diffuse pleural fibrosis labelled the immediate cause
• The authors' conclusion: The authors concluded that clinicians and pathologists should be aware that yellow nail syndrome may cause diffuse pleural fibrosis and pleural plaques without a history of asbestos exposure, including when investigating possible asbestos-related deaths

Topics

Medical terms in this study, explained in our Lexicon: Bilateral, Pleural Plaques, Diffuse Pleural Thickening, Asbestos Exposure, Biomarker, Standing, Occupational History, Pathology.

Related studies

• Asbestos-related pleural diseases: dimensional criteria are not appropriate to differentiate diffuse pleural thickening from pleural plaques — J. Ameille, M. Matrat, et al. (2004)
• Asbestos-related lesions of the pleura: parietal plaques compared to diffuse thickening studied with chest roentgenography, computed tomography, lung function, and gas exchange — G. Hillerdal, P. Malmberg, et al. (1990)
• Asbestosis, pleural plaques and diffuse pleural thickening: three distinct benign responses to asbestos exposure — P.A. Gevenois, V. de Maertelaer, et al. (1998)
• Clinical consequences of asbestos-related diffuse pleural thickening: A review — S.E. Miles, A. Sandrini, et al. (2008)
• Diffuse thickening superimposed on circumscribed pleural thickening related to asbestos exposure — A. Miller, J.A. Miller (1993)
• Asbestos-related diffuse pleural thickening — N. Fujimoto, K. Kato, et al. (2014)

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