Poncet's Disease (Reactive Arthritis Associated with Tuberculosis)

Abstract

An 82-year-old man with miliary tuberculosis was admitted to our hospital. Approximately six weeks after starting anti-tuberculosis treatment, he complained of pain in the fingers, wrists, and ankles. A histopathological examination of the synovial biopsy revealed nonspecific chronic inflammation with no granulomas. Culture of the biopsy specimen yielded no acid-fast bacilli. Poncet's disease was diagnosed based on the clinical presentation, with no findings suggestive of other diseases. His joint pain rapidly improved with steroid therapy. Tuberculosis can cause arthritis through immune-mediated mechanisms without direct invasion in an entity known as Poncet's disease.

Keywords: Poncet's disease; reactive arthritis; tuberculosis.

Figure 1.

Chest radiography on admission. Chest radiography showed patchy shadows in both upper lungs and a mass lesion in the right middle lung.

Figure 2.

Chest computed tomography (CT) on admission. (A, B) Chest CT revealed bilateral multiple nodules in a random distribution overlapping with patchy opacities and a calcified mass in the right upper lung lobe, which are suggestive of active pulmonary and miliary tuberculosis overlapping with tuberculosis sequelae.

Figure 3.

Hand radiography during the development of polyarthritis. Hand radiography showed neither bone erosion nor joint space narrowing.

Figure 4.

Magnetic resonance imaging (MRI) of the right hand (T2-weighted imaging). MRI of the right hand revealed mild synovial fluid retention without bone erosion or destruction of the cartilage and joints.

Figure 5.

Schematic diagram of the clinical course. H: isoniazid, R: rifampicin, E: ethambutol, PSL: prednisolone, CRP: C-reactive protein

Figure 6.

A histopathological examination of the synovial biopsy specimen (right wrist extensor synovitis). Hematoxylin and Eosin staining. A histopathological examination revealed nonspecific chronic inflammation with infiltration of histiocytes and lymphocytes. Granulomas were not detected.