A young woman with cystic bronchiectasis: mystery revealed

Bronchiectasis is a disabling respiratory disease which results in permanent distortion and dilatation of the affected bronchi. It is a chronic obstructive lung disease with clinical manifestations of chronic cough, sputum production, and recurrent chest infections. It has several aetiologies which include infections, primary immunodeficiency, recurrent aspiration, inhaled foreign body, cystic fibrosis and primary ciliary dyskinesia. Yellow nail syndrome (YNS) is a very rare disease with a clinical triad of nail changes, respiratory manifestations and lymphoedema. Diagnosis can be made in the presence of two of these symptoms. We present a case of a young woman with cystic bronchiectasis and maxillary sinusitis, later diagnosed with yellow nail syndrome. A 22-year-old woman diagnosed with cystic bronchiectasis for 3 years presented with an infective exacerbation. She was noted to have characteristic nail changes involving hands and feet which raised suspicion of YNS. It should be considered in a patient with bronchiectasis and characteristic nail changes, even in the absence of lymphoedema. Therefore, a high degree of clinical suspicion and exclusion of other underlying causes are necessary to arrive at a timely diagnosis.