What are the causes of secondary clubbing of the nails (digital clubbing)?

Updated: Mar 18, 2020
  • Author: Robert A Schwartz, MD, MPH; Chief Editor: William D James, MD  more...
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Causes of secondary clubbing include the following [11] :

  • Pulmonary disease - Lung cancer, [12] cystic fibrosis, interstitial lung disease, [13] idiopathic pulmonary fibrosis, [14] sarcoidosis, [15] lipoid pneumonia, empyema, pleural mesothelioma, pulmonary artery sarcoma, [16] lung hydatid cysts, [17] Eisenmenger syndrome (a severe form of pulmonary arterial hypertension), [18] and pulmonary metastases (see Dermatologic Manifestations of Pulmonary Disease)

  • Cardiac disease - Cyanotic congenital heart disease, [19] other causes of right-to-left shunting, and bacterial endocarditis (see Dermatologic Manifestations of Cardiac Disease); a scoring system for empiric treatment of infective endocarditis includes clubbing [20]

  • Gastrointestinal disease - Ulcerative colitis, Crohn disease, primary biliary cirrhosis, cirrhosis of the liver, hepatopulmonary syndrome, [21]  leiomyoma of the esophagus, achalasia, and peptic ulceration of the esophagus (see Dermatologic Manifestations of Gastrointestinal Disease) [22]

  • Skin disease - Pachydermoperiostosis, Bureau-Barrière-Thomas syndrome, Fischer syndrome, palmoplantar keratoderma, [23] and Volavsek syndrome

  • Malignancies - Thyroid cancer, thymus cancer, Hodgkin disease, [24] and disseminated chronic myeloid leukemia (POEMS [polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes] syndrome is a rare paraneoplastic syndrome secondary to a plasma cell dyscrasia in which clubbing may be seen. [25, 26] Other findings including peripheral neuropathy, organomegaly, endocrinopathy, monoclonal plasma proliferative disorder, skin changes, sclerotic bone lesions, Castleman disease, thrombocytosis, papilledema, peripheral edema, pleural effusions, ascites, and white nails.)

  • Miscellaneous conditions - Acromegaly, thyroid acropachy, pregnancy, an unusual complication of severe secondary hyperparathyroidism, [27] sickle cell disease, [28]  and hypoxemia possibly related to long-term smoking of cannabis [29]

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