每日一题_2024.06.28

A 67-year-old woman with a history of chronic rhinosinusitis presented to the emergency department with a 1-week history of dyspnea and cough. On physical examination, all 10 fingernails were yellow and thickened (upper image). Pitting edema was also present in the legs (lower image), and decreased breath sounds were detected at the left lung base. A chest radiograph showed a pleural effusion on the left side. A thoracentesis was performed, and 1.1 liters of milky, yellow fluid were removed. Findings from analysis of the pleural effusion were consistent with a chylous effusion. What single diagnosis could explain all of this patient’s findings?

一位67岁女性，有慢性鼻窦炎的病史，因一周的呼吸困难和咳嗽症状来到急诊科。在体格检查中，发现所有10个指甲都是黄色且增厚的（上图）。腿部也有凹陷性水肿（下图），并且在左肺底部检测到呼吸音减弱。胸部X光片显示左侧有胸腔积液。进行了胸腔穿刺，抽出了1.1升乳白色的黄色液体。胸腔积液的分析结果与淋巴性胸腔积液一致。以下哪个单一诊断可以解释这位患者的所有发现？

A. Autoimmune hepatitis自身免疫性肝炎

B. Graves’ disease格雷夫斯病（Graves病）

C. Lymphoma淋巴瘤

D. Psoriasis牛皮癣

E. Yellow nail syndrome黄甲综合征

答案解析：

黄甲综合征是一种罕见的疾病，其特征是黄指、趾甲色，肥厚，淋巴水肿，以及慢性胸腔积液三联症。它有时也被称为慢性遗传性淋巴水肿或先天性淋巴水肿。患者通常伴有支气管扩张和胸腔积液，后者为漏出液，可能发生在一侧或两侧。病因尚不完全清楚，但普遍认为与遗传有关，许多病例有阳性家族史，且常伴有黄甲，可能并发于肝胆疾病、溶血、甲状腺功能减退、慢性肾上腺功能不全、肾病综合症、胡萝卜素血症等。最新的研究显示，黄甲综合征可能对维生素E治疗有反应。

正确答案：E