Correct!
4. 1 and 3
The yellow nails syndrome is a rare disorder characterized by the triad of yellow and thickened nails, lymphedema and chylous pleural effusion (1). The pathogenesis of this rare syndrome remains poorly understood, but the evidence to date suggests that the lymphatic dysfunction observed is an acquired disorder. Yellow nail syndrome has been described in association with a variety of conditions including lymphoproliferative disorders, immunodeficiency states, connective tissue disorders, endocrinopathies, obstructive sleep apnea, Guillain–Barré syndrome, xanthogranulomatous pyelonephritis and tuberculosis. It seems likely that most of these associations are probably spurious.
A dermatology consult was ordered. The dermatologist thought the patient’s nails were more consistent with onychomycosis rather than yellow nail syndrome (2).
The cardiac ultrasound was reviewed and showed slow ventricular filling and abnormal heart muscle relaxation. The ventricular and septal walls were thickened. Consistent with the diagnosis of cardiomyopathy the NT-pro brain natriuretic peptide was markedly elevated at 23,000 pg/ml (normal < 300). An abdominal fat biopsy showed increased Congo red staining and apple green birefringence under polarizing microscopy (Figure 4).
Figure 4. Abdominal fat showing (A) increased Congo red staining and (B) birefringerence under polarizing microscopy.
Which of the following disorders are associated with amyloidosis? (Click on the correct answer to proceed to the seventh and final page)