Chylous ascites, intestinal lymphangiectasia and the 'yellow-nail' syndrome

In 1964 Samman and White described 13 patients with lymphoedema of the lower extremities associated with an unusual dystrophy of the finger and toe nails: this they termed the 'yellow-nail' syndrome. Affected nails were thickened, excessively curved along both axes, very slow growing and of yellowish-grey hue; cuticle and lunula were usually absent and onycholysis was frequently evident¹. Lower limb lymphangiography in most individuals revealed hypoplasia, or aplasia of the lymphatics,^1-3 similar to that occurring in primary lymphoedema:4 other patients also developed pleural effusions of high protein content ^5-7 or ascites^{3 8} suggestive of a more generalised disorder of the lymphatic system. Here we describe a patient in whom the classical 'yellow-nail' syndrome was associated with intestinal and chylous ascites.