Yellow nail syndrome accompanied by minimal-change nephrotic syndrome: A case report

Figure 1 Clinical findings and laboratory examination of the patient. A: Nails and toenails were thickened and yellow, with increased curvature. Edema was found in both lower limbs, especially in the right side; B: No tumor cells or granulomatous structures were found in hematoxylin and eosin staining images (400×) of pleura, pleural effusion, peritoneal effusion and axillary lymph nodes; C: Computed tomography (CT) images showed bilateral pleural effusions(orange arrows), pericardial effusions (yellow arrow), and peritoneal effusions (blue arrow); positron emission tomography (PET)/CT images showed enlarged axillary (orange triangle) and mediastinal (yellow triangle) lymph nodes and ethmoid sinusitis (blue triangle); D: Radionuclide lymphoscintigraphy showed that lymphatic vessels of the right lower limb were interrupted, the imaging agent (99Tc-antimony sulfide colloid) was accumulated in the subcutaneous tissue (orange arrows) and collateral circulation appeared in the lymphatic vessels below the left knee (yellow arrows).

Figure 2 Clinical findings and laboratory examination of the patient after treatment. A: bilateral pleural effusion (orange arrow), pericardial effusion (yellow arrow) and peritoneal effusion (blue arrow) decreased significantly after treatment; the enlarged lymph nodes in the axilla (orange triangle) and mediastinum (yellow triangle) shrink to the normal range; B: The edema in both lower limbs resolved.

Figure 3 Renal biopsy confirmed the diagnosis of minimal-change nephrotic syndrome. A: Mild glomerular mesangial hyperplasia under light microscopy (200×); B: Glomerular podocytes fusion under electron microscopy (2500×).

Figure 4  The changes of serum albumin and urinary protein, clinical manifestations and therapeutic drugs were summarized in chronological order.