Department of Community Medicine, Ehime University Graduate School of Medicine, Japan.
Intern Med. 2021;60(15):2499-2502. doi: 10.2169/internalmedicine.6104-20. Epub 2021 Aug 1.
Digital clubbing has been regarded as an important sign in medicine. A 33-year-old woman with no history of hepatic, pulmonary, or malignant disease was referred to our hospital. She had been taking lubiprostone every day for three years for constipation. Clubbing in her upper and lower limb digits began gradually about two years ago. The results of laboratory investigations were almost normal. We suspected the clubbed digits were a side effect of lubiprostone and confirmed that the levels of urinary prostaglandin E2 (PGE2), which can cause clubbed digits, were elevated. Thus, we instructed the woman to stop taking lubiprostone and monitored this lab value. However, the value continued to rise over 2 months to 41.9 μg/g Cr. During that time, she had been taking sennoside A B calcium instead of lubiprostone for constipation. Since sennoside A B calcium also has the effect of increasing PGE2, we ordered the discontinuation. Her urinary PGE2 to creatinine level normalized, and the clubbing improved after the discontinuation of these two medications.
杵状指已被视为医学中的一个重要征象。一位 33 岁女性，无肝、肺或恶性疾病病史，因便秘，每天服用鲁比前列酮已 3 年，约 2 年前逐渐出现四肢杵状指。实验室检查结果几乎正常。我们怀疑杵状指是鲁比前列酮的副作用，并证实可引起杵状指的尿前列腺素 E2（PGE2）水平升高。因此，我们嘱患者停用鲁比前列酮，并监测该实验室值。然而，2 个月内该值持续升高至 41.9μg/g Cr。在此期间，她因便秘改用番泻苷 A B 钙而非鲁比前列酮。由于番泻苷 A B 钙也有增加 PGE2 的作用，我们嘱其停用。停用这两种药物后，其尿 PGE2 与肌酐比值恢复正常，且杵状指改善。
