A case of rheumatoid arthritis with bucillamine-induced yellow nail syndrome initially manifesting as pulmonary disease

Abstract

We report a case of a 67-year-old woman with rheumatoid arthritis with yellow nail syndrome (YNS) that was caused by bucillamine. All three signs (yellow fingernails, lymphatic edema, and bronchiectasis) of YNS manifested, with characteristic timing, first with the nails turning yellow after when bronchiectasis was noticed. We reviewed 10 case reports from Japan and compared the periods until the appearance of yellow nails after starting bucillamine treatment, as well as those until lung disease and leg edema appeared.

Keywords: Bucillamine; Rheumatoid arthritis; Yellow nail syndrome.

Figure 1

Chest X-rays in August 21, 2001 (A), September 3, 2004 (B), and February 25, 2009 (C). A slight left pleural effusion developed on chest X-rays in August 2001, and an increase in chest fluid on X-rays was documented in September 2004. No remarkable change in February 2009.

Figure 2

Appearance of nails. All of the patient’s nails were yellow. July 2004 (A), and February 2010 (B).

Figure 3

Bilateral lower limb edema and yellow toenails. Nonpitting edema of both lower limbs was noted. July 2004 (A), and February 2010 (B).

Figure 4

Actions of bucillamine on nail plate. It is thought that the similarity in chemical structure of bucillamine to cysteine is related to its medicinal action, i.e. bucillamine would presumably alter the composition of keratin because of its structure being similar to that of cysteine.