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CASE REPORT
Year : 1996  |  Volume : 50  |  Issue : 7  |  Page : 244-246
 

Poncet's disease - Case report


1 Department of Medicine, Indira Gandhi Medical College, Shimla 171 001, India
2 Department of Microbiology, Indira Gandhi Medical College, Shimla 171 001, India

Date of Submission02-Mar-1996

Correspondence Address:
S Thakur
Department of Medicine, Indira Gandhi Medical College, Shimla 171 001
India
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PMID: 8979543

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How to cite this article:
Thakur S, Prasher B S, Sharma V. Poncet's disease - Case report. Indian J Med Sci 1996;50:244-6

How to cite this URL:
Thakur S, Prasher B S, Sharma V. Poncet's disease - Case report. Indian J Med Sci [serial online] 1996 [cited 2014 Jul 23];50:244-6. Available from: http://www.indianjmedsci.org/text.asp?1996/50/7/244/11574


Tuberculous rheumatism is poly­arthritis with visceral tuberculosis but no bacteriological evidence of joint involvement. The first detail­ed description of the disease was given by Antonin Poncet in 1897. [1] There is considerable controversy ever since French workers in the nineteenth century began to draw a possible connection between tuberculosis and rheumatoid arth­ritis. Like other reactive arthritis Poncet's disease is not considered as disease suigeneris. We present two cases of polyarthritis in pa­tients with tuberculosis in whom no other cause of polyarthritis was demonstrated, with review of literature.

Case No. 1 : Ak, 29 years old male, a partially treated case of pulmonary tuberculosis, in 1987 was admitted with polyarthritis in­volving bilaterial ankle, knee, wrist joint, and left elbow joint of one month duration and haemoptysis for three days. There was no history of dysentric illness, sexual contact, skin lesions and mouth ulcers. On examination, he had features of fibrosis left upper lobe. X ray chest revealed left upper Iobe fibrosis with calcified lesions. Sputum for AFB was positive. ESR was 50 mm in first hour and C. re­active proteins were positive. X ray ankle and knee joints revealed soft tissue swelling. Rheu­matoid factor, ANF, ASO titre and urethral smear for gonococci were negative. The patient was treated with four drugs (Strept++INH+ Rif-f-PZA). One month after treat­ment swelling of the joints subsi­ded and there was no recurrence.

Case No. 2: AP, thiry years old male came with polyarthritis of three months duration involving both ankles, knee, elbow, and wrist joints. There was no history of fever, hemoptysis, sexual con­tact, skin lesions, mouth ulcers or dysentric illness preceeding, arthritis. Examination revealed matted cervical lymph,node in the right supraclavicular region. X ray chest, Rh. factor, ANF and ASO were negative. Lymph-node biopsy and FNAC lymph-node were sug­gestive of tuberculosis. The patient was initially treated with NSAID without much improvement and after biopsy report, was treated with anti-tubercular drugs (Ri+­INH+Ethamb). The symptoms im­proved and arthritis subsided after two months and arthralgia persist­ed for one month.


 € Discussion Top


Tuberculous rheumatism is not generally accepted as a specific disease entity in Great Britain or the USA. There are isolated re­ports of this disease entity from India [2],[3] and abroad. [4],[5]] The clinical presentation may be primary tuber­culosis as the first manifestation or secondary to chest tuberculosis. The pattern of articular involve­ment is predominantly non-migra­tory, polyarticular with mild to moderate functional incapacity. Morning stiffness is usually absent. Response to anti-tubercular treat­ment with no residual deformity is usually seen. It is unclear why sterile polyarthritis should some­times complicate tuberculosis. Va­rious mechanisms like hypersen­sensitivity response to tuberculo­protein, [6] increased PPD induced reactivity of synovial fluid lympho­cytes compared with that of peri­pheral blood lymphocyte, [7] antigenic similarity between a fraction of tubercle bacilli and human carti­lage [8] and circulating immune com­plexes against synovium have been postulated. [9] Presently a cell - mediated cross reactive im­mune response to Mycobacterium tuberculosis is thought to be the cause of this reactive inflamma­tory arthropathy of Poncet's disease. A genetic predisposition may be required for a rhumatic res­ponse to M. tuberculosis, as has been proposed for other reactive arthritis and this may explain why Poncet's disease is an uncommon complication of tuberculosis. [10] Tuberculosis is common in our country and despite debate in lite­rature, polyarthritis, where etiology s obscure Poncet's disease should be considered.


 € Summary Top


Poncet's disease is a rare poly­,arthritis occurring in patients with tuberculous infection. We describe two cases of polyarthritis, one se­condary to pulmonary tuberculosis, the other secondary to tuber­culous infection of lymph nodes. In both cases the arthritis rapidly subsided with chemotherapy.

 
 € References Top

1.Poncet A. Delapdyarthrite tuber­culeuse deformanteou pseudo-rheu­matism chronique tuberculex, Con­gres francasis dechirugie. 1897; 1:732-739.  Back to cited text no. 1      
2.Chandrasekran AN, Achuthan K, Prathiban PL. Tuberculous rheu­matism. I The Madras experience and review of literature. Antisep­tic. 1990;7:333-338.  Back to cited text no. 2      
3.Malik SK, Khatri GK, Deodhar SD. Tuberculous rheumatism, J Ind Med Assn 1977;69:201-202.  Back to cited text no. 3      
4.Isaacs AJ, Sturrock R.D. Poncet's disease fact or fiction Tubercle. 1974;55:135-142.  Back to cited text no. 4      
5.Wilkinson MC. A note on Poncet's tuberculous rheumatism. Tubercle. 1967;48:297-306.  Back to cited text no. 5      
6.Wallace R, Cothen AS. Tuberculous arthritis. a report of two cases with review of biopsy and synovial fluid findings. Am J Med 1976;62:277-282.  Back to cited text no. 6      
7.Southwood TR, Hancock EJ, Petty RE, Malison PN, Thiessan PN. Tuberculoous: rheumatism (Pon­set's disease) in a child. Arthritis and Rheumatism. 1988;31:1311-­1311.  Back to cited text no. 7      
8.Holoshitz J, Drucker I, Cohen PR. T-lymphocytes of Rheumatoid Ar­thritis patients show augumented activity to a fraction of Mycobac­terium cross reactivity with carti­lage. Lancet 1986;11:305-309.  Back to cited text no. 8      
9.Bhatacharya A, Ranadive SM, Kalem Bhatacharya S. Antibody based enzyme linked immunosur­bent assay for determination of immune complexes in clinical tuberculosis. Am Rev Respite Dis 1986;19:184-205.  Back to cited text no. 9      
10.Summers GD, Jayson, MIV. Does Poncet's disease exist? Rheumatol Rehabil 1980;19:149-150.  Back to cited text no. 10      



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