Recurrent pleural effusions and yellow nails - what’s the cause?

An interesting but difficult to diagnose case

A 58-year-old male with a history of recurrent pleural effusions presents with worsening dyspnoea and lower extremity oedema. 

feet

Examination reveals bilateral pitting oedema of his legs and feet and yellow, dystrophic nails on his fingers and toes. Chest X-ray demonstrates a large right pleural effusion. 

A diagnosis of yellow nail syndrome is suspected and thoracentesis is performed. 

Which of the following characteristics would you expect to find on pleural fluid analysis? 

A) Pleural fluid-to-serum protein ratio of <0.5 
B) Xanthochromia

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