IDIOPATHIC CLUBBING - PATHOGENETIC MECHAN ISMS AND DIFFERENTIAL-DIAGNOSIS

We report on a patient with marked clubbing of the fingers and toes wi th watch-glass deformity of the nails, diagnosed as idiopathic clubbin g. New findings on the pathogenesis of clubbing provide evidence for t he important role of cytokines, especially platelet-derived growth fac tor and tumor necrosis factor-alpha. The differential diagnosis includ es, besides rare primary forms, clubbing in malignant neoplasias and c hronic inflammatory diseases of the heart, the lung, the upper gastroi ntestinal tract and the liver. Clubbing can precede other symptoms of neoplasias by months and could be dependent on a genetic predispositio n.