Case Report
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Apr 16, 2015; 3(4): 385-388
Published online Apr 16, 2015. doi: 10.12998/wjcc.v3.i4.385
Poncet’s disease: An unusual presentation of tuberculosis in a diabetic lady
Partha Pratim Chakraborty, Sayantan Ray, Chitra Selvan, Rana Bhattacharjee, Sanjay Kumar Mandal
Partha Pratim Chakraborty, Sayantan Ray, Chitra Selvan, Rana Bhattacharjee, Department of Endocrinology, IPGMER and SSKM Hospital, Kolkata 700020, West Bengal, India
Sanjay Kumar Mandal, Department of General Medicine, Medical College and Hospital, Kolkata 700073, West Bengal, India
Author contributions: Chakraborty PP and Ray S contributed to conception and design; Ray S and Selvan C contributed to drafting of the article; Selvan C contributed to literature search; Chakraborty PP contributed to analysis and interpretation of data; Bhattacharjee R and Mandal SK contributed to critical revision of the article for important intellectual content; Chakraborty PP, Ray S, Selvan C, Bhattacharjee R and Mandal SK final approval of the article.
Ethics approval: The Institutional Ethical Committee of IPGME and R, Kolkata agreed to give its formal approval to carry out this case study in this institution.
Informed consent: Patient gave informed consent for the information about her to appear in the journal publications.
Conflict-of-interest: No conflict of interest to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Dr. Sayantan Ray, Department of Endocrinology, IPGMER and SSKM Hospital, 244, AJC Bose Road, Kolkata 700020, West Bengal, India.
Telephone: +91-92-31674135 Fax: +91-92-31674135
Received: September 27, 2014
Peer-review started: September 28, 2014
First decision: December 17, 2014
Revised: January 20, 2015
Accepted: February 4, 2015
Article in press: February 9, 2015
Published online: April 16, 2015

Authors describe a 53-year-old woman who presented to their diabetes clinic with a three week history of multiple painful and swollen joints. She had been diagnosed with type 2 diabetes 5 years back. On examination, both knee joints and left ankle were swollen. A soft tissue swelling appeared over the medial end of the left clavicle few days later. Rheumatoid arthritis, collagen vascular diseases and other common causes of polyarthritis were ruled out by appropriate investigations. Non steroidal anti-inflammatory drugs failed to give satisfactory pain relief and the arthritis persisted. Conventional cultures of synovial fluid samples including cultures for tuberculosis were negative. Computed tomography showed a space occupying lesion involving the left sternoclavicular joint. Fine needle aspiration from the lesion was performed and acid-fast bacilli were demonstrated in the smear using Ziehl-Neelsen stain. The explanation of her arthritis was therefore tuberculous arthritis in left sternoclavicular joint and reactive arthritis in the rest of the joints. A diagnosis of Poncet’s disease was considered in her case. We treated her with standard anti-tuberculosis drugs and the arthritis resolved within a few days. She remained symptom-free at her 2 years’ follow-up.

Keywords: Poncet’s disease, Diabetes, Tuberculous arthritis, Reactive arthritis, Acid-fast bacilli

Core tip: Poncet’s disease (PD) is a form of reactive arthritis that develops in patients with active tuberculosis (TB). It is a rare, non-destructive parainfective symmetric polyarthritis. In cases of unexplained atypical arthritis associated with non-articular TB, PD should be considered. PD remains a clinical challenge and is essentially a diagnosis of exclusion and requires a high degree of clinical suspicion. Correct identification of this rare complication of TB is required to avoid delayed initiation of appropriate treatment. The dramatic response of arthritis in PD on starting anti-tubercular treatment substantiates the diagnosis. Further studies are required for better understanding of the pathogenesis underlying PD.