Abstract
Cutaneous tuberculosis is a rare extrapulmonary manifestation of tuberculosis which, like disseminated tuberculosis, commonly occurs in immunocompromised patients. Poncet reactive arthritis is a seronegative arthritis affecting patients with extrapulmonary tuberculosis, which is uncommon even in endemic countries. We report a previously healthy 23-year-old male patient with watery diarrhea associated with erythematous ulcers on the lower limbs and oligoarthritis of the hands. Histopathological examination of the skin showed epithelioid granulomatous process with palisade granulomas and central caseous necrosis. AFB screening by Ziehl–Neelsen staining showed intact bacilli, the culture was positive for Mycobacterium tuberculosis, and colonoscopy revealed multiple shallow ulcers. Disseminated tuberculosis associated with reactive Poncet arthritis was diagnosed, with an improvement of the clinical and skin condition after appropriate treatment.
Highlights
Tuberculosis (TB) is one of the most common diseases in humans, its cutaneous form is rare and represents about 1---2% of cases of extrapulmonary TB, which corresponds to 10% of the total cases.[1,2] Clinically, there are three types: endogenous cutaneous TB, exogenous cutaneous TB or tuberculids[3] The treatment usually performed with rifampicin, isoniazid, pyrazinamide and ethambutol (RIPE) provides resolution of cutaneous TB cases
Disseminated tuberculosis associated with reactive arthritis of Poncet in an immunocompetent patient
Tuberculosis is considered multifocal when there is involvement of at least two extrapulmonary sites, with or without pulmonary involvement. It accounts for one-third of the mortality among patients infected with the human immunodeficiency virus (HIV), but it can affect immunocompetent patients.[4]
Summary
Tuberculosis (TB) is one of the most common diseases in humans, its cutaneous form is rare and represents about 1---2% of cases of extrapulmonary TB, which corresponds to 10% of the total cases.[1,2] Clinically, there are three types: endogenous cutaneous TB (by hematogenous spread), exogenous cutaneous TB (by inoculation) or tuberculids (hypersensitivity reaction to Mycobacterium tuberculosis)[3] The treatment usually performed with rifampicin, isoniazid, pyrazinamide and ethambutol (RIPE) provides resolution of cutaneous TB cases. Disseminated tuberculosis associated with reactive arthritis of Poncet in an immunocompetent patient.
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