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Cureus 2019 Mar 11;11(3):e4216. Epub 2019 Mar 11.

Gastroenterology and Hepatology, John H. Stroger Jr. Hospital of Cook County, Chicago, USA.

Paraneoplastic gastrointestinal syndromes rarely precede the actual detection of an overt cancer with gastroparesis being a very rare initial presentation. To increase the clinical awareness of this rare clinical entity, we present a case of severe gastroparesis that was later proven to be associated with an occult poorly differentiated non-small cell lung cancer. We then continue to briefly review the relevant literature on paraneoplastic gastrointestinal syndromes to date. Read More

BMJ Case Rep 2019 Mar 31;12(3). Epub 2019 Mar 31.

Cardiology, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India.

A 14-year-old boy of Asian origin presented with a history of bluish discolouration of the finger and toenail bed with associated mild fatiguability on exertion since early childhood. Clinical examination revealed bilaterally symmetric uniform central cyanosis with no associated clubbing. Cardiovascular and respiratory system examination was normal. Read More

J Eat Disord 2019 5;7. Epub 2019 Mar 5.

3Department of Renal medicine, Gosford Hospital, Gosford, Australia.

Background: The link between clubbing and laxative abuse has been reported several times in the literature, in all cases in young females. The nature of this relationship is not understood.

Case: A young female, with no history of hepatic, pulmonary or malignant disease was found to have nail clubbing in the context of laxative abuse. Read More

Ned Tijdschr Geneeskd 2017;161:D1807

Maastricht Universitair Medisch Centrum+, afd. Kindergeneeskunde, Maastricht.

A 4-year-old boy was referred because of pan-digital clubbing and watch-glass nails. Other remarkable findings were: surgical closure of a patent arterial duct, decreased knee-mobility and consanguineous parents. This combination is suggestive for primary hypertrophic osteoarthropathy (PHO; #OMIM 259100). Read More

Ann Dermatol Venereol 2017 Dec 12;144(12):799-803. Epub 2017 Sep 12.

Department of Dermatology, hôpital Saint-Louis, AP-HP, 1, avenue Claude-Vellefaux, 75475 Paris cedex 10, France; MAGEC, hôpital Saint-Louis, AP-HP, 1, avenue Claude-Vellefaux, 75475 Paris cedex 10, France. Electronic address:

Background: Pachydermoperiostosis is a rare autosomal recessive genetic disorder characterized by the association of periostosis and pachydermia. To date, two genes involved in prostaglandin metabolism, HPGD and SLCO2A1, have been identified.

Patients And Methods: A 7-year-old girl presented digital clubbing of the hands and feet, curved nails, hyperhidrosis, and pachydermia, as well as eczema of the trunk and limbs. Read More

Kyobu Geka 2016 Nov;69(12):1003-1007

Department of Surgery, Oita Prefectural Hospital, Oita, Japan.

A 40-year-old woman was noted to have clubbing of the nails during an outpatient service for smoking cessation. Chest computed tomography showed an aneurysm of an aberrant artery running from the descending aorta to the left lower lobe. Hence, we diagnosed anomalous systemic arterialization of the lung. Read More

Br J Dermatol 2017 08 22;177(2):546-548. Epub 2017 Jun 22.

Human Medical Genetics and Genomics Program, University of Colorado School of Medicine, Aurora, CO, 80045, U.S.A.

Rev Med Chil 2016 Apr;144(4):516-20

POEMS syndrome is characterized by Polyneuropathy, Organomegaly, Endocrinopathy, Monoclonal protein and Skin changes. We report a woman with the syndrome, who had peripheral polyneuropathy, osteosclerotic myeloma, monoclonal IgA elevation, hypothyroidism, hypogonadotrophic hypogonadism, hyperprolactinemia, adrenal insufficiency, hepatosplenomegaly, lymphadenopathy, thyroid and parotid enlargement, Castleman’s disease, papilledema, stiff and hyperpigmented skin, white nails, clubbing, ascites and chronic diarrhea. She had also a nephropathy characterized by microscopic hematuria, proteinuria, renal insufficiency and a unilateral kidney retraction. Read More

Ann Dermatol Venereol 2016 Apr 2;143(4):284-8. Epub 2016 Mar 2.

Service de dermatologie, hôpital Saint-André, CHU de Bordeaux, 1, rue Jean-Burguet, 33000 Bordeaux, France. Electronic address:

Background: Acro-osteolysis (AO) involves partial or total destruction of the distal phalanges of the fingers or toes. The range of forms of AO is extremely wide. A distinction is generally made between the acquired forms and the genetic and idiopathic forms. Read More

Prim Care 2015 Dec;42(4):677-91

Department of Family and Community Medicine, Penn State Milton S. Hershey Medical Center, 500 University Avenue, Hershey, PA 17033, USA. Electronic address:

A variety of nail deformities commonly presents in the primary care office. An understanding of nail anatomy coupled with inspection of the nails at routine office visits can reveal undetected disorders. Some problems are benign, and treatment should be attempted by the primary care provider, such as onychomycosis, paronychia, or ingrown toenails. Read More

Z Rheumatol 2015 Oct;74(8):728-30

Klinik für Rheumatologie, HELIOS Seehospital Sahlenburg, Nordheimstr. 201, 27476, Cuxhaven, Deutschland.

Secondary hypertrophic osteoarthropathy, also known as Marie-Bamberger disease, occurs in up to 5 % of patients with non-small cell lung cancer (NSCLC). If the syndrome constellation of finger clubbing and bone pain on palpation is recognized early, lung cancer can be diagnosed at an early stage. This article reports the case of a 52-year-old male patient with knee pain, distal edema, watchglass nails and finger clubbing which first appeared in August 2013. Read More

Presse Med 2014 Nov 23;43(11):1208-15. Epub 2014 Oct 23.

Nail disease centre, 42, rue des Serbes, 06400 Cannes, France. Electronic address:

For those interested in nails, a fairly good knowledge of the anatomy of the nail unit is indispensable. But nothing will replace a careful, clinical examination of the nail apparatus. The shape of the nail, surface abnormalities and coloration, with or without a magnifying glass, may well provide a medical diagnosis not only in dermatology but also for medicine in general. Read More

J Rheumatol 2014 Mar 15;41(3):523-7. Epub 2014 Jan 15.

From the UK National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan; Department of Radiology, Faculty of Medicine, Shimane University, Shimane, Japan; Medical Physics and Engineering, Leeds Teaching Hospitals UK National Health Service (NHS) Trust, Leeds, UK.

Objective: Hypervascularization in finger clubbing is recognized, but its microanatomical basis remains unclear. This pilot descriptive study used magnetic resonance imaging (MRI) to explore this further.

Methods: High-resolution MRI acquired with contrast agent was carried out in 4 patients with finger clubbing and 4 healthy volunteers. Read More

Int J Dermatol 2013 Nov 4;52(11):1349-56. Epub 2013 Apr 4.

Department of Dermatology, Mayo Clinic, RochesterDepartment of Laboratory Medicine and Pathology, Mayo Clinic, RochesterDivision of Hematology, Mayo Clinic, RochesterDivision of Clinical Biochemistry and Immunology, Mayo Clinic, RochesterDivision of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA.

Background: Polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes syndrome is a rare multisystem paraneoplastic condition associated with plasma cell dyscrasia.

Methods: From our institution's dysproteinemia database, 107 patients met criteria for polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes syndrome between January 1, 2000, and October 1, 2009. Medical records were reviewed for documented syndrome features at diagnosis. Read More

Saudi J Kidney Dis Transpl 2013 Jan;24(1):36-40

Department of Nephrology, Golestan University of Medical Sciences, Gorgan, Iran.

Mucocutaneous manifestations are common among patients on hemodialysis (HD). This study was undertaken to determine the prevalence of mucocutaneous manifestations in patients with end-stage renal disease (ESRD) who are on HD. In this cross-sectional, descriptive and analytic study conducted in 2009, 100 patients on HD at the Five Azar Hospital in Gorgan city were randomly selected. Read More

Int J Dermatol 2013 Jan;52(1):1-5

Second Affiliated Hospital, Chongqing Medical University, China.

Background: Current methods to diagnose clubbing have drawbacks. This study was done to test a novel and convenient method for the diagnosis of digital clubbing using high-frequency ultrasound.

Methods: Index fingers from a healthy control group without digital clubbing and a patient group with digital clubbing were examined by ultrasound. Read More

Interact Cardiovasc Thorac Surg 2012 Dec 11;15(6):1080-1. Epub 2012 Sep 11.

Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium.

A 46-year old male patient was admitted with a history of an extremely painful right upper arm, associated with unilateral clubbing. Duplex scanning and magnetic resonance imaging were suggestive of a pseudo-aneurysm of the brachial artery. Digital angiography showed an irregular brachial artery, associated with a small pseudo-aneurysm. Read More

J Invest Dermatol 2012 Oct 14;132(10):2473-2476. Epub 2012 Jun 14.

Center for Human Genetics, Bioscientia, Ingelheim, Germany; Department of Human Genetics, RWTH Aachen University, Aachen, Germany; Center for Clinical Research, University Hospital Freiburg, Freiburg, Germany. Electronic address:

Am Fam Physician 2012 Apr;85(8):779-87

Cleveland Clinic, Stongsville, OH, USA.

Knowledge of the anatomy and function of the nail apparatus is essential when performing the physical examination. Inspection may reveal localized nail abnormalities that should be treated, or may provide clues to an underlying systemic disease that requires further workup. Excessive keratinaceous material under the nail bed in a distal and lateral distribution should prompt an evaluation for onychomycosis. Read More

An Pediatr (Barc) 2012 Aug 13;77(2):141-2. Epub 2012 Apr 13.

Anadolu Kardiyol Derg 2012 Apr 20;12(3):E14-5. Epub 2012 Apr 20.

Clinic of Cardiology, Türkiye Yüksek İhtisas Hospital, Ankara, Turkey.

Hand Surg 2011 ;16(3):383-6

Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Seoul National University Bundang Hospital, Seongnam, Korea.

The authors present a case that developed acute painful nail hypertrophy of the ipsilateral four fingers which resembled finger clubbing after undergoing elective hand surgery on the little finger. The patient was diagnosed as having complex regional pain syndrome (CRPS), and the nail hypertrophy subsided gradually on pain control, and completely normalized one year after onset. Recognizing this phenomenon may help initiate early treatment for CRPS and avoid unnecessary antibiotic or antifungal medications for postoperative infection. Read More

Hautarzt 2011 Oct;62(10):722-5

Hautklinik, Universitätsklinikum Düsseldorf.

POEMS syndrome is a rare paraneoplastic syndrome due to a plasma cell dyscrasia, which includes peripheral neuropathy, organomegaly, endocrinopathy, monoclonal plasma cell proliferation and skin changes. Elevated levels of VEGF (vascular endothelial growth factor) in the serum of patients are suggested to play a pivotal role in the pathophysiology. A 60-year-old male presented with POEMS syndrome and painful edema, skin thickening of the distal extremities and livid-erythematous discoloration. Read More

J Assoc Physicians India 2010 Apr;58:253-5

Department of Medicine, Sawai Man Singh Medical College and Hospital, Jaipur, India.

A case of pachydermoperiostosis presented to us in rheumatology clinic with complaints of pain and swelling in knee joints unresponsive to treatment, characteristic facial features, grade four clubbing of nails and broadening of distal parts of extremities. He also complained of fatiguability which was due to anemia. The natural history of the disease was reviewed and investigated. Read More

JAMA 2010 Jul;304(2):159-61

Pulmonology Service, Complexo Hospitalario Universitario de Vigo, Vigo, Spain.

Indian J Gastroenterol 2009 Jul-Aug;28(4):154-6. Epub 2009 Nov 24.

Department of Surgical Gastroenterology, Jaslok Hospital and Research Centre, Mumbai 400 026, India.

We report a 6-year-old girl who received a left-lobe live-related liver transplant for decompensated liver disease after a failed Kasai's surgery for biliary atresia. Preoperatively, her nails were white, dystrophic, brittle with severe onycholysis, clubbing and watch-glass deformities. Nail scrapings were negative for fungus. Read More

J Eur Acad Dermatol Venereol 2010 Jun 2;24(6):649-54. Epub 2009 Nov 2.

Department of Dermatology and Venereology, Zagazig University, Zagazig, Egypt.

Background: Liver cirrhosis, hepatitis C virus (HCV) and hepatitis B (HBV) virus infections are known to be associated with different skin disorders. Nail changes are additional important criteria, which would help in identification of these systemic diseases.

Objective: To record the nail abnormalities in patients with liver disease which were not reported before, especially those with HCV and HBV infection. Read More

Ned Tijdschr Geneeskd 2009 ;153:B425

St. Antonius Ziekenhuis, afd. Longziekten, Nieuwegein, The Netherlands.

Objective: To describe the clinical presentation, diagnosis, and prognosis of a cohort of Dutch patients with idiopathic pulmonary fibrosis (IPF), a serious and rapidly progressive lung disease belonging to the idiopathic interstitial pneumonias.

Design: Retrospective study of patient records.

Method: The data from the clinical presentation, diagnosis, treatment and survival of all patients with IPF, diagnosed in the St. Read More

Dtsch Med Wochenschr 2009 Sep 28;134(36):1741-2. Epub 2009 Aug 28.

Internistisch-rheumatologische Schwerpunktpraxis, Tal 6, 80331 München.

Ir J Med Sci 2012 Jun 9;181(2):257-61. Epub 2009 May 9.

Department of Medicine, The Children's Hospital of Zhejiang University School of Medicine, 57 Zhugan Xiang, 310003, Hangzhou, China.

Aim: To highlight the clinical features and diagnosis of cranio-osteoarthropathy, an extremely rare disease.

Methods: Case report and literature review.

Result: A 2. Read More

Ned Tijdschr Geneeskd 2009 Feb;153(7):298-303

Atrium Medisch Centrum Parkstad, Afd. Reumatologie, Heerlen.

Ir J Med Sci 2009 Sep 9;178(3):351-3. Epub 2008 Oct 9.

Department of Cardiology, Uludağ University Medical Faculty, 16059 Bursa, Turkey.

Pulmonary diseases such as malignancies, empyema, bronchiectasis, digestive tract malignancies, inflammatory bowel diseases, cyanotic congenital heart diseases and infective endocarditis can cause clubbing. We present a 63-year-old female patient with infective endocarditis, who had clubbing that resolved very rapidly after cardiac surgery due to rupture of the mitral papillary muscle. She had persistent fever and in her echocardiographic examination rupture of the papillary muscle of the anterior mitral valve and significant aortic regurgitation was noted. Read More

J Med Genet 2009 Jan 19;46(1):14-20. Epub 2008 Sep 19.

Department of Biochemistry, Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad, Pakistan.

Background: Isolated congenital nail clubbing (ICNC) is a rare autosomal recessive disorder characterised by enlargement of the terminal segments of fingers and toes with thickened nails due to proliferation of the connective tissues and abnormal function of the nail matrix. In the present study, we investigated a large Pakistani family with 11 affected individuals having hereditary congenital nail clubbing as a single invariable clinical feature without any associated ectodermal, skeletal or systemic imperfection.

Objective: To identify a gene underlying the ICNC phenotype. Read More

J Eur Acad Dermatol Venereol 2008 Nov 5;22(11):1326-31. Epub 2008 Jun 5.

Department of Dermatology & Venereology, Zagazig University, Zagazig, Egypt.

Background: Chronic renal failure is known to cause various nail pathologies. They may be directly related to the renal condition itself or its complications or to the therapy.

Objective: To compare nail changes in end-stage renal failure patients under haemodialysis with healthy persons and to study the potential relationship with various parameters in the patients. Read More

Clin Anat 2008 May;21(4):314-8

The Post-Graduation Program in Chest Medicine Sciences, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.

It is established that there is an increase in soft tissue of the clubbed digits as demonstrated on previous histopathological examinations. In the present study, the nail bed thickness was assessed and measured on plain radiographs of index fingers in two groups of patients: one group with lung disease and fingers clubbing and one group of normal controls. A vertical x-ray beam was used with a focus-film distance of 1. Read More

Niger J Med 2008 Jan-Mar;17(1):83-7

AIDS Prevention Initiative Nigeria Centre, Jos University Teaching Hospital, Jos, Nigeria.

Background: The clinical characteristics and consequences of HIV-I infection observed in studies from developed countries cannot be generalized across the multiple virus subtypes that circulate in sub-Saharan Africa in general and Nigeria in particular. This study was therefore conducted to determine the commonest symptoms and signs at presentation in HIV-infected individuals at the Jos University Teaching Hospital.

Method: This descriptive study was conducted at the antiretroviral clinic of the Jos University Teaching Hospital, Jos, between May and October 2004. Read More

Acta Reumatol Port 2007 Jul-Sep;32(3):282-6

Serviço de Radiologia, Hospital Santo Espirito de Angra no Heroísmo, Ponta Delgada.

The authors present the clinical case of a 61-year-old male admitted to the emergency department, with arthritis of his right wrist and left knee as well as left leg cellulitis, digital clubbing and 'hourglass' nails. Subsequent clinical work-up led to the final diagnosis of stage IV adenocarcinoma of the lung, with bone metastasis. The authors discuss the association between this type of lung neoplasm and osteoarticular manifestations as well as its first presentation as bone metastasis. Read More

J Assoc Physicians India 2006 Jun;54:506

Dermatol Clin 2006 Jul;24(3):341-7

Department of Dermatology, University of Bologna, Via Massarenti 1-40138, Bologna, Italy.

Although abnormalities of the nails have been reported in different systemic disorders,most of these abnormalities are nonspecific. This article reports and discusses only those nail signs that provide the clinician with clues for the diagnosis of systemic disorders. Read More

Medicina (B Aires) 2006 ;66(2):147-9

División Reumatología, Hospital de Clínicas José de San Martín, Facultad de Medicina, Universidad de Buenos Aires.

Pachydermoperiostosis or primary hypertrophic osteoarthropathy is a rare disease characterized by cutaneous and osteoarthicular involvement. We describe two patients with finger clubbing, watch crystal nails, bones thickenings, arthritis and different grades of skin affection, without other clinical manifestations. Both did not know of having relatives with the same alterations. Read More

Expert Opin Pharmacother 2005 Jun;6(6):945-53

Division of Hematology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.

POEMS syndrome is a rare paraneoplastic syndrome secondary to a plasma cell dyscrasia. Recognition of the complex of a combination of peripheral neuropathy, organomegaly, endocrinopathy, monoclonal plasmaproliferative disorder, skin changes, sclerotic bone lesions, Castleman's disease, thrombocytosis, papilledema, peripheral oedema, pleural effusions, ascites, fingernail clubbing and white nails, is the first step in effectively managing the disease. More than 95% of patients will have monoclonal lambda sclerotic plasmacytoma(s) or bone marrow infiltration. Read More

Curr Treat Options Oncol 2004 Jun;5(3):249-57

Division of Hematology and Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.

POEMS (polyneuropathy, organomegaly, endocrinopathy, M protein, and skin changes) syndrome is a rare multisystemic paraneoplastic syndrome driven by an underlying plasma cell dyscrasia. More than 95% of patients will have monoclonal lambda sclerotic plasmacytoma(s) or bone marrow infiltration. Recognition of the complex of a combination of peripheral neuropathy, organomegaly, endocrinopathy, monoclonal plasmaproliferative disorder, skin changes, sclerotic bone lesions, Castleman disease, thrombocytosis, papilledema, peripheral edema, pleural effusions, ascites, fingernail clubbing, and white nails is the first step in effectively managing the disease. Read More

Am Fam Physician 2004 Mar;69(6):1417-24

Thomas M. Hart Family Practice Residency Program, York Hospital, York, Pennsylvania 17405, USA.

The visual appearance of the fingernails and toenails may suggest an underlying systemic disease. Clubbing of the nails often suggests pulmonary disease or inflammatory bowel disease. Koilonychia, or "spoon-shaped" nails, may stimulate a work-up for hemochromatosis or anemia. Read More

Ned Tijdschr Geneeskd 2004 Jan;148(2):53-6

Afd. Longziekten, VU Medisch Centrum, Postbus 7057, 1007 MB Amsterdam.

In four patients, a man aged 53, a woman aged 63 and two men aged 67 and 53 years, respectively, inspection of the hand led to the final diagnosis. In the first patient who presented with clubbing of the fingers and pulmonary hypertension, a small atrial septal defect was detected. The second patient had thick curved yellow nails and recurrent pleural effusions as part of this yellow nail syndrome. Read More

J Eur Acad Dermatol Venereol 2003 Jan;17(1):73-6

Dipartimento Osteo-Articolare, Unità Operativa di Reumatologia e Medicina Interna, Azienda Ospedaliera di Parma, Via Gramsci, 14, 43100 Parma, Italy.

A 33-year-old man, suffering from cutaneous psoriasis since the age of 16, in the last 6 years experienced slow and painless enlargement at his fingertips and later at his big toes, which resulted in digital clubbing. Since the age of 31, the patient also presented psoriatic nail changes involving all his fingernails, without joint pain or inflammation. The patient's family history was negative for psoriasis, however, his brother, a 29-year-old healthy man, also presented digital clubbing. Read More

J Orthop Surg (Hong Kong) 2001 Jun;9(1):61-66

Department of Orthopaedic Surgery, Kasturba Medical College and Hospital, Karnataka, India.

Three patients with pachydermoperiostosis are reported. All patients presented with moderate pain and swelling in multiple joints unresponsive to treatment, characteristic facial features which were marked in two cases, clubbing of nails and enlargement of distal parts of the extremities. One patient had spondylolisthesis of L5-S1 vertebrae, an association not previously described in this syndrome. Read More

JAMA 2001 Jul;286(3):341-7

Queen's University, Hotel Dieu Hospital, 166 Brock St, Kingston, Ontario, Canada K7L 5G2.

Context: The association between digital clubbing and a host of diseases has been recognized since the time of Hippocrates. Although the features of advanced clubbing are familiar to most clinicians, the presence of early clubbing is often a source of debate.

Objective: To perform a systematic review of the literature for information on the precision and accuracy of clinical examination for clubbing. Read More

Trop Gastroenterol 2001 Jan-Mar;22(1):14-7

Department of Gastroenterology, Institute of Postgraduate Medical Education and Research, 244, AJC Bose Road, Calcutta 700020.

Till date only three series of immunoproliferative small intestinal disease (IPSID) describing 22 patients have been reported from India. Seven patients with IPSID in two tertiary referral centers in India are included in the study. Diagnosis was based on typical clinical features [diarrhoea (7/7), weight loss (7/7), clubbing (6/7), fever (3/7), abdominal pain and lump (3/7)], biochemical evidence of malabsorption and duodenal biopsy findings. Read More