PMC8381167_01
At the first visit to the hospital. Her digits showed a loss of the normal <165  angle (Lovibond angle) between the nailbed and the fold (cuticula), increased convexity of the nail fold, and thickening of the whole distal end of the finger (resembling a drumstick).
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An examination of her hands and feet revealed drumstick-type clubbing of her fingers and toes (Fig. 1).
Clinical course.
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As shown in Fig. 2, the level of urinary PGE2 to Cr was remarkably high at 45.1 mug/g Cr [Japanese healthy controls: median 13.1, interquartile range 10.3-17.2 mug/g Cr as reported in previous studies ].
Seven months after lubiprostone and sennoside A B calcium discontinuation. Her digits show a normal Lovibond angle between the nailbed and the fold and improved thickening of the whole distal end of the finger.
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Her urinary PGE2-to-Cr level normalized to 15.3 mug/g Cr, and the clubbing improved after the discontinuation of these medications (Fig. 3).