Poncet's disease: An unusual presentation of tuberculosis in a diabetic lady

Authors describe a 53-year-old woman who presented to their diabetes clinic with a three week history of multiple painful and swollen joints. She had been diagnosed with type 2 diabetes 5 years back. On examination, both knee joints and left ankle were swollen. A soft tissue swelling appeared over the medial end of the left clavicle few days later. Rheumatoid arthritis, collagen vascular diseases and other common causes of polyarthritis were ruled out by appropriate investigations. Non steroidal anti-inflammatory drugs failed to give satisfactory pain relief and the arthritis persisted. Conventional cultures of synovial fluid samples including cultures for tuberculosis were negative. Computed tomography showed a space occupying lesion involving the left sternoclavicular joint. Fine needle aspiration from the lesion was performed and acid-fast bacilli were demonstrated in the smear using Ziehl-Neelsen stain. The explanation of her arthritis was therefore tuberculous arthritis in left sternoclavicular joint and reactive arthritis in the rest of the joints. A diagnosis of Poncet's disease was considered in her case. We treated her with standard anti-tuberculosis drugs and the arthritis resolved within a few days. She remained symptom-free at her 2 years' follow-up.