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Poncet ’ s disease: two case reports

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ABSTRACT

Background: One of the rare presentations of active pulmonary or even extrapulmonary tuberculosis is polyarthropathy which is the involvement of multiple large and small joints in the body; a reactive constellation known as Poncet’s disease. This may sometimes be the sole manifestation of the disease before more obvious features develop. The pain experienced during polyarthritis can be crippling thereby limiting the mobility and activities of patients. Polyarthritis as a symptom of active tuberculosis can be easily misinterpreted for more common causes of polyarthritis such as rheumatological diseases that present similarly.

Case presentation: We describe the case of a 25-year-old Asian woman and a 45-year-old Asian man who presented with active tuberculosis where polyarthralgia was the first and only symptom for many months followed by pulmonary and pleural manifestations. Both patients showed dramatic improvement with anti-tuberculous therapy. The total duration of therapy was 6 months.

Conclusions: Based on our observations, we propose that tuberculosis be included among the differentials for patients with unusual presentation of joint pains, especially in endemic regions and/or susceptible populations.

No MeSH data available.


a Chest X-ray and b computed tomography scan of the chest showing multiple fine nodularities bilaterally in all lung fields
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Fig3: a Chest X-ray and b computed tomography scan of the chest showing multiple fine nodularities bilaterally in all lung fields

Mentions: A chest X-ray revealed mild bilateral pleural effusion and left-sided lower lobe consolidation (Fig. 2a). A computed tomography (CT) scan of his chest re-demonstrated the effusions and also showed hilar lymphadenopathy (Fig. 2b). Aspiration revealed exudative effusion (protein of 5400 mg/dL, lactate dehydrogenase of 3274 IU/L) with lymphocytic pleocytosis (leukocyte count of 800 with 90% lymphocytes) and low glucose (51 mg/dL). A pleural fluid AFB smear and culture were negative. His hemoglobin level was 9.4 g/dL, ESR 111 mm/hour, and CRP 21.6 mg/dl. ANA (homogenous) and RF were all positive and anti-citrullinated cytoplasmic peptide antibody was 119. An X-ray of his joints did not reveal any joint erosions or abnormalities. A high-resolution CT scan of his chest and a repeated chest X-ray 1 week later revealed multiple fine nodules bilaterally in all lung fields consistent with miliary TB (Fig. 3).Fig. 2


Poncet ’ s disease: two case reports
a Chest X-ray and b computed tomography scan of the chest showing multiple fine nodularities bilaterally in all lung fields
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC5382461&req=5

Fig3: a Chest X-ray and b computed tomography scan of the chest showing multiple fine nodularities bilaterally in all lung fields
Mentions: A chest X-ray revealed mild bilateral pleural effusion and left-sided lower lobe consolidation (Fig. 2a). A computed tomography (CT) scan of his chest re-demonstrated the effusions and also showed hilar lymphadenopathy (Fig. 2b). Aspiration revealed exudative effusion (protein of 5400 mg/dL, lactate dehydrogenase of 3274 IU/L) with lymphocytic pleocytosis (leukocyte count of 800 with 90% lymphocytes) and low glucose (51 mg/dL). A pleural fluid AFB smear and culture were negative. His hemoglobin level was 9.4 g/dL, ESR 111 mm/hour, and CRP 21.6 mg/dl. ANA (homogenous) and RF were all positive and anti-citrullinated cytoplasmic peptide antibody was 119. An X-ray of his joints did not reveal any joint erosions or abnormalities. A high-resolution CT scan of his chest and a repeated chest X-ray 1 week later revealed multiple fine nodules bilaterally in all lung fields consistent with miliary TB (Fig. 3).Fig. 2

View Article: PubMed Central - PubMed

ABSTRACT

Background: One of the rare presentations of active pulmonary or even extrapulmonary tuberculosis is polyarthropathy which is the involvement of multiple large and small joints in the body; a reactive constellation known as Poncet’s disease. This may sometimes be the sole manifestation of the disease before more obvious features develop. The pain experienced during polyarthritis can be crippling thereby limiting the mobility and activities of patients. Polyarthritis as a symptom of active tuberculosis can be easily misinterpreted for more common causes of polyarthritis such as rheumatological diseases that present similarly.

Case presentation: We describe the case of a 25-year-old Asian woman and a 45-year-old Asian man who presented with active tuberculosis where polyarthralgia was the first and only symptom for many months followed by pulmonary and pleural manifestations. Both patients showed dramatic improvement with anti-tuberculous therapy. The total duration of therapy was 6 months.

Conclusions: Based on our observations, we propose that tuberculosis be included among the differentials for patients with unusual presentation of joint pains, especially in endemic regions and/or susceptible populations.

No MeSH data available.