Management of chylothorax and chylous ascites due to yellow nail syndrome with indwelling catheters: a case report

Background: Yellow nail syndrome (YNS) is a rare condition characterized by yellow nails, lymphedema, and respiratory disease. Chylous ascites and chylothorax often occur in these patients and can be managed by dietary modifications, medications, and surgical procedures. Amongst the various modalities available to manage recurrent effusions due to YNS, indwelling pleural catheters (IPCs) and indwelling abdominal catheters are safe treatment options. Our case is unique because the treatment of YNS chylous ascites with an indwelling abdominal catheter has not yet been described in the literature. Our patient did not experience any complications of infection, malnutrition, or electrolyte disturbances. Case Description: We describe the case of a 77-year-old female with YNS who developed multiple chylous effusions over the course of several years. She was initially assessed for management of her left chylous pleural effusion after developing dyspnea on exertion, worsening orthopnea, and cough. At this time, she had an established diagnosis of YNS. After multiple thoracentesis, the left pleural effusion was managed with an IPC which was subsequently removed after pleurodesis was achieved. Approximately a year later she developed a recurrent right-sided pleural effusion which was definitively managed with a video-assisted thoracoscopy with talc poudrage. Approximately 3 years later she was referred to a respirologist who made changes to her lymphedema management which included dietary modifications, intramuscular octreotide, and furosemide. Despite these treatments, she had persisting leg lymphedema and was treated with leg compression dressings for her leg lymphedema, which resulted in the development of chylous ascites. Due to the need for recurrent paracentesis, the decision was made to insert an indwelling abdominal catheter. She did not experience any complications from the catheter and it was eventually removed due to a lack of ascites. Conclusions: This case suggests that indwelling catheters are a safe and effective approach to managing effusions and ascites in patients with YNS.