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October 2001
This patient has digital clubbing, which occurs when the angle between the nail plate and the proximal nail fold is greater than 180 degrees. While the exact pathogenesis is unknown, digital clubbing has been associated with disease processes in various organ systems. Cyanotic congenital heart disease and bacterial endocarditis are among the cardiac diseases associated with clubbing, while chronic pneumonia, cystic fibrosis, tuberculosis, and lymphoid interstitial pneumonitis are among the pulmonary processes. Gastrointestinal diseases associated with clubbing include inflammatory bowel disease, chronic dysentery, and chronic active hepatitis.
Tuberculosis, cystic fibrosis, and gastrointestinal and liver diseases were excluded by the primary care physician utilizing history, physical examination, and various laboratory and radiographic examinations. During this time, the patient’s mother died. The mother’s autopsy report noted findings consistent with AIDS. The patient subsequently was tested for HIV and was found to be HIV-infected. The patient was referred to a pediatric HIV specialist.
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