[Nail Clubbing].

Area of Science:

• Pulmonology
• Oncology
• Clinical Medicine

Background:

• Chronic Obstructive Pulmonary Disease (COPD) exacerbations are common, particularly in smokers.
• Nail clubbing is an uncommon physical finding, with rare documented associations with COPD alone.
• Investigating atypical symptoms is crucial for uncovering underlying pathologies.

Purpose of the Study:

• To report a rare case of nail clubbing in a patient with COPD exacerbation.
• To illustrate the diagnostic pathway initiated by an unusual clinical sign.
• To emphasize the association between nail clubbing and underlying lung cancer.

Main Methods:

• Clinical examination of a patient presenting with COPD exacerbation.
• Diagnostic assessment including physical examination for nail clubbing (hyponychial angle, Schamroth sign).
• Further investigations including pulmonary CT-scan and biopsy for suspected malignancy.

Main Results:

• A 78-year-old male smoker with severe COPD (GOLD 3E) presented with exacerbation.
• Physical examination revealed significant nail clubbing.
• Subsequent investigations identified a peri-hilar mass, confirmed as small cell lung cancer via biopsy.

Conclusions:

• Nail clubbing, though rare in COPD, can be an indicator of underlying lung cancer.
• This case underscores the necessity of a thorough patient history and diagnostic workup when encountering uncommon clinical signs.
• Early detection of lung cancer, potentially aided by recognizing subtle physical findings like nail clubbing, is critical.