October - LRS Institute of Tuberculosis & Respiratory Diseases

Ind. J. Tub., 1986, 33, 183
REVERSIBILITY OF CLUBBING IN PULMONARY TUBERCULOSIS
A Case Report
B.K. KHANNA AND K.S. KHARE
Summary : A case of pulmonary tuberculosis, with advanced clubbing of left index finger nail, showing a total
reversal of clubbing, (by subjective observations and by measurement of hyponychial angle from finger cast)
following 11 months of antituberculosis chemotherapy, has been reported
Clubbing has been Reported in pulmonary
tuberculosis in less than 1 % (Weirman, Clagett,
and McDonald 1954) to 90% cases (Pyke
1954). Almost, all the studies have been based
on clinical observation alone. Mellins and
Fishman (1966) recommended the use of
alginate impression material for production
of accurate casts of digits. The method is accurate,
reproducible and provides an objective
reference material (Regan, Tagg and Thomson
1967; and Bently, Moore & Schwachman 1976).
During our study on subjective and
objective assessment of clubbing in patients
suffering from pulmonary tuberculosis, we
came across a case of advanced clubbing
which completelyr eversed with
cmotherapeutic treatment. The case is being
presented below.
Case Report
A male patient, aged 32 years, was admitted
to our hospital on 10-8-1983. The duration
of symptoms was said to be about five months
before reporting to us. His sputum was positive
for acid fast bacilli on smear examination.
Clinical and radiographic examination of the
patient revealed no other pathology except
for bilateral pulmonary tuberculosis. Four
lung zones were involved and the disease was
mainly fibro-cavitary.
Detailed clinical examination of left index
finger nail revealed evidence of advanced
clubbing e.g, increased curvature of finger
nail and marked swelling of nail bed. The tissue
surrounding the nail bed was warm, red and
shiny. A finger cast was taken and measurement
of hyponychial angle by shadow graph (Mefarlane,
Ibrahim and Tor-Agbidye 1979) revealed it
to be 205°.
The patient was administered streptomycin
(Ig/lmi OD) isoniazid (300 mg/day after
breakfast) and PAS (5 g twice a day after
meals). He was discharged after 2½ months
of stay in the hopsital, by which time, his
clinical condition had improved considerably.
Clinically, the curvature of the nail and swelling
of the nail bed had reduced markedly. Warmth,
shinyness and redness of the tissue at the nail
bed had also decreased. At his home, the
patient continued to take PAS and isoniazid
(in the same dosage). At the end of 11 months
of total treatment, he had improved clinically,
radiographically and bacteriologically. Skiagram
of the chest showed marked improvement. Cavity
was reduced in size and its wall had become
thinner. Furthermore, all evidence (subjective
and objective) of clubbing had disappeared. A
repeat finger cast of the same finger revealed a
hyponychial angle of 185° (Figure 1).