Background Poncet's disease, named after a French surgeon, Antonin Poncet, is a rare form of polyarthritis occurring in patients with tuberculous infection. It is an immunological reaction to tuberculoprotein wherein CD4+ cells together with bacterial antigens migrate into the joints after infection thus causing symmetric polyarthritis. Patients would clinically present with fever, malaise, polyarthritis of the large joints such as the knees, ankles and wrists. Around 6% of patients with Poncet's disease would have erythema nodosum, which is a tender red nodule or lump that is usually seen on both shins produced by inflammation of fat cells under the skin (panniculitis) spontaneously resolving after 3-6 weeks. It is more often associated with extrapulmonary TB infection than pulmonary TB. The diagnosis is largely clinical and is made by excluding other causes of polyarthirits.
We report a case of a 39 year old female newly diagnosed with Tuberculous Mastitis via core biopsy, presenting with acute symmetric polyarthritis and erythema nodosum. Polyarthritis workup was unremarkable and symptoms were not relieved by non-steroidal anti-inflammatory drugs and steroids, but had complete resolution of symptoms after 6 weeks of anti-koch's therapy. To our knowledge, this is the first case report of Poncet's disease associated with Tuberculous mastitis.
Conclusions Poncet's disease is a form of polyarthritis affecting patients with tuberculous infection. It is a diagnosis of exclusion but must be included in differential diagnosis especially in countries/regions where prevalence of M. tuberculosis infection is high.
Early initiation of anti-Koch's therapy is the treatment thus in patients with a background or exposure to tuberculosis with polyarthritis refractory to NSAIDs and steroids, a high index of suspicion for Poncet's disease is advantageous.
Bhargava, Anurag D., et al. Tuberculous Rheumatism (Poncet's Disease) – A Case Series. Ind. J. Tub., 1998, 45, 215
Disclosure of Interest : None declared
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