A 24-year-old man receiving treatment for cavitary pulmonary tuberculosis develops pain and swelling of both ankles, knees and wrists over two weeks. Synovial fluid is sterile on routine and mycobacterial culture, rheumatoid factor is negative, and radiographs show soft tissue swelling without erosions. Symptoms resolve completely within six weeks of optimizing antitubercular therapy. What is the diagnosis?
- A Rheumatoid arthritis triggered by infection
- B Poncet disease (tuberculous rheumatism) ✓
- C Reactive arthritis following enteric infection
- D Gouty arthropathy secondary to pyrazinamide
Correct answer: B. Poncet disease (tuberculous rheumatism)
Explanation
Poncet disease is a form of polyarthritis associated with active tuberculosis elsewhere in the body. It is believed to be a hypersensitivity phenomenon: the joints are sterile, rheumatoid factor is negative, radiographs show no destructive change, and the arthritis characteristically remits with antitubercular therapy alone. Rheumatoid arthritis would persist and progress independently of TB treatment, which distinguishes it from this presentation.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.