Clubbed Digits Presumably Caused by Lubiprostone

Area of Science:

• Endocrinology
• Gastroenterology
• Dermatology

Background:

• Digital clubbing is a significant clinical sign, often associated with underlying diseases.
• Lubiprostone and sennoside A B calcium are commonly used for constipation management.

Observation:

• A 33-year-old woman developed digital clubbing after three years of lubiprostone use.
• Elevated urinary prostaglandin E2 (PGE2) levels were detected, correlating with clubbing.
• Clubbing persisted and worsened despite switching to sennoside A B calcium.

Findings:

• Both lubiprostone and sennoside A B calcium were implicated in elevating urinary PGE2 levels.
• Discontinuation of both medications led to normalization of PGE2 levels.
• Digital clubbing significantly improved following medication withdrawal.

Implications:

• This case highlights a potential drug-induced etiology for digital clubbing.
• Monitoring PGE2 levels may be useful in cases of unexplained digital clubbing.
• Clinicians should consider medication side effects in the differential diagnosis of digital clubbing.