Digital clubbing: the bad omen that endures

Digital clubbing is an important clinical sign that is usually associated with serious condition. Most of the diseases causing clubbing are thoracic, but it is sometimes seen in gastrointestinal or endocrinal disorders. In heavy smokers, thoracic malignancy is the most important entity that needs to be ruled out in patients who exhibit clubbing. Here, we will present a case in which a male heavy smoker who exhibited acute exacerbation of chronic obstructive pulmonary disease and had clubbing, neither had any malignancy on chest computed tomography nor any other medical explanation for the sign. Six months after the first presentation, the patient developed pleural effusion that turned out to be mesothelioma.