Clubbing Due to Laxative Abuse.

A 49-year-old woman with chronic constipation presented with a 2-year history of gradual terminal digit and toe enlargement. A physical examination revealed clubbing of all digits and toes (Picture A-C). The Schamroth sign was positive: the diamond-shaped window normally seen between nailbeds when the distal phalanges are opposed was absent (Picture D). Laboratory data revealed no notable findings except for hypokalemia (3.1 mEq/L). Whole-body computed tomography, an electrocardiogram, and echocardiography findings revealed no underlying clubbing-associated conditions. Investigations into her bowel management revealed that she had been consuming at least 50 tablets of an over-the-counter laxative (bisacodyl) daily for 35 years. Although we suggested discontinuing the laxative, she was unable to do so, and the clubbing remained unchanged. The Schamroth sign is a clinical sign of nail clubbing (1). Acquired clubbing has been associated with pulmonary, cardiovascular, and neoplastic diseases. Long-term laxative abuse has been also reported as a rare cause of clubbing (2). Thus, clinicians should consider this and record the medication history (including over-the-counter laxative use) carefully.

Picture.

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