Clubbing in an Anorexia Nervosa Patient.

A 32-year-old woman was evaluated for cellulitis of the lower legs. She was hospitalized in a psychiatric ward for the treatment of anorexia nervosa. On physical examination, she was severely emaciated (body mass index, 11.2) with clubbing of all fingers and toes (Picture). She had noticed this condition several years previously. Although the cellulitis was completely treated with antibiotics, the clubbing of the fingers and toes remained unchanged. Imaging studies and laboratory data showed no organic diseases that may have caused clubbing other than severe hypokalemia (2.5 mEq/L). We carefully inquired about her bowel movements, and discovered that the patient had a more than 15-year history of senna laxative misuse (3 times the recommended dose).

Picture.

Clubbing is a rare complication of anorexia. In malnourished patients with anorexia nervosa, clubbing seems to be associated with long-term laxative abuse (1,2); however, the pathophysiological basis for this remains to be elucidated.