జర్నల్ ఆఫ్ ట్రాపికల్ డిసీజెస్ & పబ్లిక్ హెల్త్

నైరూప్య

Poncets disease & gastrocnemius abscess: An unusual presentation of tuberculosis in a diabetic man

Ema Dianita

Poncets’s disease (tuberculous rheumatism) was rare and challenging complication of tuberculosis (TB) infection, therefore frequently missed. It can happen in all TB-infection phase and should be one of much differential diagnosis of poly- or oligoarthritis in TB endemic area.

We describe the case of a 47-year-old Asian man who presented with active tuberculosis where two week-reactive bilateral arthritis of the knee was the symptom followed pulmonary manifestation. He was treated with anti-tuberculosis drugs for four months before arthritis appeared. Poncet’s disease was our diagnosis and 6-month antituberculosis, as well as non-steroid anti-inflammatory drugs (NSAID) were given. Diabetes mellitus was the only risk factor of this immunocompromised state.

Two weeks later, bilateral gastrocnemius abscess then thought as complication of the arthritis. But, unmatched conventional culture result of synovial fluid and abscess made us wondered if Poncet’s disease is really sterile reactive arthritis or there was undetected microbe artefact? Furthermore, his arthritis and abscess completely respond to 3rd generation of Cephalosporin as the first choice of antibiotic according to abscess culture.

This case highlights the need for increased awareness among physicians regarding this rare complication of common disease to avoid delay in diagnosis and starting the appropriate treatment.