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Case Report
An interesting case of fever, rash, and polyarthritis
1 Postgraduate Trainee (PGY3), Department of General Medicine, R.G. Kar Medical College and Hospital, Kolkata, West Bengal, India
2 Postgraduate Trainee (PGY2), Department of General Medicine, R.G. Kar Medical College and Hospital, Kolkata, West Bengal, India
3 Assistant Professor, Department of General Medicine, R.G. Kar Medical College and Hospital, Kolkata, West Bengal, India
4 Professor, Department of General Medicine, R.G. Kar Medical College and Hospital, Kolkata, West Bengal, India
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Uddalak Chakraborty
158, Chakdah Padma Pukur, Purba Putiary, Kolkata 700093, West Bengal,
India
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Article ID: 100053Z09UC2019
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Chakraborty U, Paria TK, Chandra A, Pal J. An interesting case of fever, rash, and polyarthritis. J Case Rep Images Med 2019;5:100053Z09UC2019.ABSTRACT
Introduction: Poncet’s disease is a parainfective reactive arthritis seen with active tuberculosis (TB) where no mycobacteria can be demonstrated in the affected joints. This rare entity has been reported mainly with extrapulmonary TB, but very rarely associated with pulmonary TB and still remains a diagnosis of exclusion.
Case Report: We report a case of a 15-year-old boy who presented to us on June 2018 with low grade fever, cough with mucoid expectoration, and bilateral symmetrical nonerosive polyarthritis along with palpable purpura of both lower limbs and buttocks. On extensive investigations, he was diagnosed with secondary pulmonary TB on the basis of sputum examination (cartridge-based nuclei acid amplification test, CBNAAT) and radiological findings. Ultrasonography of the affected joints showed synovial thickening with minimal effusion in right knee joint, whereas joint fluid CBNAAT was negative ruling out intraarticular TB. Investigations were extensively carried out to rule out other autoimmune/infectious cause of the polyarthritis and rash, which was finally attributed to Poncet’s disease. Skin biopsy revealed perivascular infiltration of fragmented neutrophils and lymphocytes, suggestive of leukocytoclastic vasculitis, supported by direct immunofluorescence test in favor of immunoglobulin A (IgA) vasculitis/Henoch–Schönlein purpura (HSP). The rash resolved simultaneously while the polyarthritis improved markedly with anti-tubercular therapy. Hence a rare association of Poncet’s disease with pulmonary TB and IgA vasculitis/HSP was made in this case.
Conclusion: Tuberculosis may have protean manifestations even rash and arthritis, hence a clinician must be vigilant while dealing with such a constellation of symptoms.
Keywords: Pulmonary tuberculosis, Poncet’s disease
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Acknowledgments
We thank Dr. Debasish Dey, Assistant Professor, Department of Radiodiagnosis, R.G. Kar Medical College and Hospital, Kolkata for helping us with radiological investigations.
We also thank Dr. Sudip Ghosh, Associate Professor, Department of Dermatology, R.G. Kar Medical College and Hospital, Kolkata for helping us with skin biopsy.
Uddalak Chakraborty - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Tarun Kumar Paria - Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Atanu Chandra - Substantial contributions to conception and design, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Jyotirmoy Pal - Revising it critically for important intellectual content, Final approval of the version to be published
Guaranter of SubmissionI would like to state that this case report is an original manuscript and neither any part nor whole has been published previously in any journal in hard copy/electronic format nor being considered actively for publication elsewhere. All co-authors have made a subsequent contribution to the design of manuscript and have actively contributed in the diagnosis and management of the case. This manuscript is free from falsification, fabrication, and plagiarism. This is an original work and I am ready to bear full responsibility and liability regarding this literature. I would like to be the guarantor of submission of this article.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2019 Uddalak Chakraborty et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
