Abstract
BackgroundOne 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 presentationWe 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.ConclusionsBased 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.
Highlights
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
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
Tuberculous rheumatism (Poncet’s disease) is a rare, reactive acute-onset polyarthritis associated with active extra-articular tuberculosis (TB) [1, 2]
Summary
Tuberculous rheumatism (Poncet’s disease) is a rare, reactive acute-onset polyarthritis associated with active extra-articular tuberculosis (TB) [1, 2]. Her ESR decreased to 55 mm/hour and CRP to 1.9 mg/dl Ten days after her steroids were discontinued, she presented with extreme worsening of all her symptoms, a constant fever of 37.8 °C (100 °F), an additional 2 kg weight loss, and non-productive cough. Case 2 A 45-year-old Asian man presented with a 12-month history of pain in multiple joints without any prior trauma, and without accompanying swelling or erythema He reported a considerable decline in his functionality with an inability to carry out even daily routine activities, being restricted to a wheelchair for the last few days. 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) He was subsequently started on standard ATT regimen (as for Case 1) and prednisone was tapered over the ensuing few months. He improved further and maintained good health 5 months after completion of ATT
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