Poncet’s disease (tuberculous rheumatism) in a Nigerian male: a frequently overlooked diagnosis

Airenakho Emorinken, Asuwemhe J. Ugheoke, Oluwaseun R. Agbadaola, Babara Okoh


Poncet’s disease is an uncommon syndrome and a reactive polyarthritis associated with active tuberculosis with no evidence of mycobacterial infection of the joint. The condition is different from tuberculous arthritis which is usually monoarticular and caused by direct tubercular involvement of the joint. There has been a paucity of case reports on Poncet’s disease in Nigeria despite the high incidence of tuberculosis. We report a case of a 45-year male who presented with inflammatory polyarthritis involving the knees, wrists, ankles, small joints of the hands bilaterally of four weeks duration. This was preceded by three week’s history of productive cough. Chest radiograph and sputum Gene Xpert revealed features consistent with tuberculosis. Synovial fluid from knee joint effusion showed no evidence of mycobacterium tuberculosis. He was diagnosed to have Poncet’s disease based on the clinical findings and investigation results. He was commenced on antituberculous medications with complete resolution of symptoms after two months. Poncet’s disease is a rare manifestation of tuberculosis and should be considered a differential in any case of active tuberculosis presenting with arthritis. The correct and prompt identification of this condition by clinicians is important with the aim of instituting the appropriate therapy.


Poncet’s disease, Polyarthritis, Tuberculous rheumatism

Full Text:



Sumalata C, Arundhathi B. Skeletal Tuberculosis- Review of Literature and Few case reports. Pulm Resp Med Int J. 2018;1(1):26–8.

Golsha R, Mehravar F, Esboie AA, Rafiee S, Rafiee S. The epidemiology of skeletal tuberculosis in northeast of Iran: A review of 229 cases. Iran J Med Sci. 2018;43(4):380–5.

Sharma A, Pinto B, Dogra S, Sharma K, Goyal P, Sagar V, et al. A case series and review of Poncet’s disease, and the utility of current diagnostic criteria. Int J Rheum Dis. 2016;19(10):1010–7.

Rueda JC, Crepy MF, Mantilla RD. Clinical features of Poncet’s disease. from the description of 198 cases found in the literature. Clin Rheumatol. 2013;32(7):929–35.

Erkol İnal E, Keskin D, Bodur H. A Case of Poncet’s Disease: Tuberculous Rheumatism. Turk J Phys Med Rehab. 2015;61(1):77–9.

Breedveld FC, Trentham DE. Progress in the understanding of inducible models of chronic arthritis. Rheum Dis Clin North Am. 1987;13(3):531–44.

Fehr A, El-Nouby F, Eltony A, Abdelkareem Y, Bogdady S. Poncet disease, tuberculosis-arthritis: a case report in upper Egypt and a review of the literature. Egypt Rheumatol Rehabil. 2017;44:39–42.

Mehrotra V, Garg K, Devi P, Chauhan S. A commonly missed diagnosis: Poncet’s disease. J Indian Acad Oral Med Radiol. 2019;31(2):176–80.

Kroot EJA, Hazes JMW, Colin EM, Dolhain RJEM. Poncet ’ s disease : reactive arthritis accompanying tuberculosis . Two case reports and a review of the literature. Rheumatology. 2007;46:484–9.

Lugo-Zamudio GE, Yamamoto-Furusho JK, Delgado-Ochoa D, Nuñez-Farfa RM, Vargas-Alarcón G, Barbosa-Cobos RE, et al. Human leukocyte antigen typing in tuberculous rheumatism: Poncet’s disease. Int J Tuberc Lung Dis. 2010;14(7):916–20.

Holoshitz J, Klajman A, Drucker I, Lapidot Z, Yaretzky A, Frenkel A, et al. T Lymphocytes of Rheumatoid Arthritis Patients Show Augmented Reactivity To a Fraction of Mycobacteria Cross-Reactive With Cartilage. The Lancet. 1986; 328(8502):305–9.

Ottenhoff T., Torres P, De Las Aguas J, Fernandez R, Van Eden W, De Vries R., et al. Evidence for an Hla-Dr4-Associated Immune-Response Gene for Mycobacterium Tuberculosis. Lancet. 1986;328(8502):310–3.

Malik SK, Khatri GK, Deodhar SD. Tuberculous rheumatism (Poncet’s disease). J Indian Med Assoc. 1977;69(9):201–2.

Heinemann C, Kaatz M, Elsner P. Erythema induratum of Bazin and Poncet’s disease - Successful treatment with antitubercular drugs. J Eur Acad Dermatol Venereol. 2003;17(3):334–6.

Perez C, Torroba L, Gonzalez M, Vives R, Guarch R. Unusual presentation of tuberculous rheumatism (Poncet’s disease) with oral ulcers and tuberculid. Clin Infect Dis. 1998.26(4):1003–4.

Dall L, Long L, Stanford J. Poncet’s Disease : Tuberculous Rheumatism. Rev Infect Dis. 1989;11(1):105–7.

Ozgul A, Baylan O, Taskaynatan MA, Kalyon TA. Poncet’s disease (tuberculous rheumatism): Two case reports and review of the literature. Int J Tuberc Lung Dis. 2005;9(7):822–4.

Shobha V, Desai AM. Poncet’s disease diagnostic criteria decodes conundrum: Poncet’s vs pseudo poncet’s. Reumatismo. 2019;71(1):46–50.