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54-Year-Old Male With Yellowing of Fingernails

Can you diagnose this case?

David L. Kaplan 2014 Series Editor @ University of Missouri – Kansas City School of Medicine

Signs and Symptoms

A 54-year-old male presented for evaluation of his fingernails and toenails, which have been turning yellow over the past 6 months, but are currently asymptomatic. The nail changes were preceded by recurrent chronic sinusitis, which had been treated with a variety of antibacterial antibiotics, but an infection still persists. The patient is otherwise healthy.

The patient’s doctor did not think a fungal infection was the cause, but referred the patient for further evaluation.

What is your approach?

Choose one to reveal diagnosis and discussion

Clip nails for fungal culture
Clip nails for histopathology with fungal stains
Start a course of oral terbinafine
Refer to ear, nose, and throat specialist or allergist to treat the sinusitis
Obtain a chest x-ray

Answer: Refer to ear, nose, and throat specialist or allergist to treat the sinusitis

See the full case at Consultant360

Yellow nail syndrome is a rare condition of yellow nails associated with respiratory disease and lymphedema. The etiology remains obscure and the condition is benign. Most patients improve when the underlying respiratory condition is successfully treated. Nail clippings and culture will be negative. Oral antifungal therapy will not help the nails unless the sinus infection is fungal. A chest x-ray is not unreasonable given the association.


Maldonado F, Ryu JH. Yellow nail syndrome. Curr Opin Pulm Med. 2009;15(4):371-375