This 16-year-old girl presented wwith a 2 month history of discoloration and thickening of the finger nails and toe nails. She failed to improve with oral antifungal therapy, and fungal cultures were subsequently negative. She had a history of recurrent upper and lower respiratory tract infections, chronic nonproductive cough and intermittent dyspnea. She was treated for recurrent left serous ofitis media because of a dull yellow tympanic membrane. Further evaluation included a chest x-ray and computed tomography which demonstrated laft basilar scarring with pleural thickening. Pulmonary function tests showed mild obstructive lung disease.
diffuse dark yellowing of the nails with increased transverse curvature