Poncet’s disease: An unusual presentation of tuberculosis in a diabetic lady

Abstract

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.