Polyarticulark Arthritis in a 17-Year-Old Boy: Poncet's Disease or a Masquerader?

Abstract

Poncet's disease is a rare form of reactive arthritis described in people with active Tuberculosis (TB). We report a case of Poncet's disease in a 17-year-old boy who posed a diagnostic challenge because of the presence of purulent effusion from affected joints. His arthritis preceded pulmonary symptoms which were in fact mild and largely subclinical. Clinical remission occurred within 10 days of anti-Tuberculous therapy and the diagnosis of Poncet's disease was established. The case highlights the need to consider Tuberculosis as a cause of arthritis even in the absence of established Pulmonary Tuberculosis especially in endemic areas.was described by the Frenchman Poncet in 1897 and is often polyarticular. This case was reported because of the diagnostic challenge it posed and the relative rarity of Poncet's disease. It should always be considered in people with polyarticular arthritis for whom most of the common causes have already been ruled out. Case DescriptionA 17-year-old boy presented to us with fever and painful swelling of the right shoulder and elbow joints for 4 days' duration. The following joints were also swollen and painful howbeit at a lesser extent; left shoulder, left elbow, both knees and right ankle. The hip joint was initially spared, and all the small joints were also spared. He was not a known sickle cell disease patient, did not have symptoms of anaemia, and had no rashes, oral ulcers, early morning joint stiffness, dysuria, urethral discharge, night sweats, anorexia, recent sore throat, or dysphagia. He however had 10 episodes of non-bloody, non-mucoid diarrhoea a day prior to presentation.On examination, he looked small for age, mildly pale, febrile with temperature of 38.1 °C and had a hyperactive precordium but no lymphadenopathy or erythema nodosum. The right shoulder, right elbow and left ankle were swollen, warm and tender. All the large joints except both hips were tender on passive motion. Frank pus was drained from two of the affected joints; analysis showed pus cells, WBC of 9,000 with neutrophils