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Case Reports
. 2025 Sep 15;64(18):2755-2759.
doi: 10.2169/internalmedicine.4935-24. Epub 2025 Mar 29.

Bucillamine-induced Yellow Nail Syndrome with Chylothorax

Yukari Hisamoto  1 , Yoriyuki Murata  2 , Kazuki Matsuda  3 , Koji Narikiyo  4 , Taiga Kobayashi  4 , Kosei Yonezawa  1 , Keita Murakawa  2 , Kazuki Hamada  2 , Syuichiro Ohata  3 , Toshiaki Utsunomiya  2 , Yoshikazu Yamaji  3 , Keiji Oishi  2 , Maki Asami-Noyama  2 , Nobutaka Edakuni  2 , Tomoyuki Kakugawa  5 , Tsunahiko Hirano  2 , Kazuto Matsunaga  2
Affiliations
Case Reports

Bucillamine-induced Yellow Nail Syndrome with Chylothorax

Yukari Hisamoto et al. Intern Med. .

Abstract

Yellow nail syndrome (YNS), a rare condition characterized by thickened yellow nails, lymphedema, and respiratory manifestations, is rarely caused by bucillamine, an anti-rheumatic agent. Respiratory manifestations of YNS include chylothorax in 18.8-22% of patients with pleural effusion. We herein report the first case of bucillamine-induced YNS with chylothorax. Lymphangiography revealed narrowing of the lymphatic vessels and stagnation of the lymphatic fluid, suggesting impaired lymphatic drainage. The chylothorax persisted despite the discontinuation of bucillamine. The present case illustrates that bucillamine can cause irreversible lymphatic impairment and chylothorax.

Keywords: bucillamine; chylothorax; lymphangiography; yellow nail syndrome.

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Conflict of interest statement

The authors state that they have no Conflict of Interest (COI).

Figures

Figure 1.
Figure 1.
Pleural effusion with a milky white appearance.
Figure 2.
Figure 2.
(A) Plain chest radiography showing right pleural effusion. (B and C) Contrast-enhanced computed tomography showing findings of sinusitis, right pleural effusion, and chronic lower respiratory tract infection in the right middle lobe.
Figure 3.
Figure 3.
Nails of hands (A) and toes (B) are thickened and yellow in color.
Figure 4.
Figure 4.
(A) Lymphangiography with bilateral inguinal puncture showing no ascending contrast. (B) Computed tomography performed the day after lymphangiography showing contrast in the thoracic ducts (arrow).
Figure 5.
Figure 5.
Yellow nails of hands growth retardation improved after the discontinuation of bucillamine.
See this image and copyright information in PMC

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