Abstract
Reactive arthritis in tuberculosis (TB) is known as Poncet’s disease, a rare aseptic form of arthritis characterized by polyarticular impairment observed in patients with active TB, with no evidence of direct bacillary invasion of the joints. The literature related to this syndrome is scarce and restricted to case reports, which contributes to its underdiagnosis. This study aimed at reporting a case of Poncet’s arthritis diagnosed at our hospital, and at reviewing the diagnostic and therapeutic aspects involved; hence, we describe a case of Poncet’s disease in a 13-year-old girl whose reactive arthritis overshadowed other clinical symptoms of TB, resulting in delayed diagnosis and treatment. Anti-TB treatment was initiated. Clinical remission occurred after 2 weeks and the diagnosis of Poncet’s arthritis was established, concluding that taking a thorough medical history and performing relevant examinations and investigations for possible TB, especially in endemic areas, will help expedite the diagnostic process even in the absence of TB symptoms.
Highlights
The incidence of tuberculosis (TB) has increased exponentially
Poncet’s disease (PD) is a rare syndrome first introduced in 1897 by the Frenchman Antonin Poncet when he described a polyarthritis in an acute stage of TB, which resolved without joint damage
PD is characterized by articular affection in patients diagnosed with TB, not related to direct invasion by the micro-organism, but to an immune reaction to the tuberculous protein, constituting a reactive arthritis
Summary
The incidence of tuberculosis (TB) has increased exponentially. According to the WHO, in 2007, the incidence of new TB cases was 9.27 million [1]; TB remains a major source of morbidity and mortality worldwide [2]. PD is characterized by articular affection in patients diagnosed with TB, not related to direct invasion by the micro-organism, but to an immune reaction to the tuberculous protein, constituting a reactive arthritis This case is reported because of its rarity, and in a TBendemic area of a country such as Upper Egypt, one should keep this possibility in mind in patients with polyarthritis, as early recognition of this complication is of major importance to avoid delayed initiation of appropriate treatment [6]. The patient was hospitalized, and additional laboratory testing was performed, which was negative for mononucleosis, toxoplasmosis, cytomegalovirus, salmonellosis, brucellosis, and HIV; acute rheumatic fever was excluded because of noncompletion of the modified Jones criteria. A chest radiography showed only increased bronchopulmonary markings with no focal lesions
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