Case Report
Poncet’s disease: unusual presentation of a common disease Shalabh Arora, Turaka Vijay Prakash, Ronald Albert Carey, Samuel George Hansdak
A 30-year-old baker from South India, with no relevant medical history, presented to the internal medicine department in April, 2015, with 6 weeks of low grade fever, fatigue, and progressive polyarthritis affecting the large joints of his arms and legs, no small joint involvement, and no diurnal variation. He reported no contact with tuberculosis or high risk sexual behaviour. On examination he was febrile (38·9oC) and had multiple dull red tender nodules on the forehead, left cheek, and sternum. He had a solitary 1 × 1 cm firm right cervical lymph node. Musculoskeletal examination showed active arthritis of the knee, hip, and elbow joints bilaterally. The liver was palpable 4 cm below the right costal margin (liver span 16 cm). Examination was otherwise normal. Our differential diagnoses initially included reactive arthritis, post-streptococcal reactive arthritis, adult onset Still’s disease, and small-medium vessel vasculitis. The skin lesions, thought to be erythema nodosum in an atypical location, were not characteristic of reactive arthritis. Ongoing fever did not support the diagnosis of post-streptococcal arthritis; adult onset Still’s disease is a diagnosis of exclusion; rheumatoid arthritis and psoriatic arthritis were less likely in view of the absence of small joint involvement or characteristic skin and nail changes; and Löfgren’s syndrome was unlikely since he had no respiratory symptoms. He had normal full blood count and erythrocyte sedimentation rate (6 mm/h). C-reactive protein was raised (131 mg/L; reference range
Poncet’s disease: unusual presentation of a common disease Shalabh Arora, Turaka Vijay Prakash, Ronald Albert Carey, Samuel George Hansdak
A 30-year-old baker from South India, with no relevant medical history, presented to the internal medicine department in April, 2015, with 6 weeks of low grade fever, fatigue, and progressive polyarthritis affecting the large joints of his arms and legs, no small joint involvement, and no diurnal variation. He reported no contact with tuberculosis or high risk sexual behaviour. On examination he was febrile (38·9oC) and had multiple dull red tender nodules on the forehead, left cheek, and sternum. He had a solitary 1 × 1 cm firm right cervical lymph node. Musculoskeletal examination showed active arthritis of the knee, hip, and elbow joints bilaterally. The liver was palpable 4 cm below the right costal margin (liver span 16 cm). Examination was otherwise normal. Our differential diagnoses initially included reactive arthritis, post-streptococcal reactive arthritis, adult onset Still’s disease, and small-medium vessel vasculitis. The skin lesions, thought to be erythema nodosum in an atypical location, were not characteristic of reactive arthritis. Ongoing fever did not support the diagnosis of post-streptococcal arthritis; adult onset Still’s disease is a diagnosis of exclusion; rheumatoid arthritis and psoriatic arthritis were less likely in view of the absence of small joint involvement or characteristic skin and nail changes; and Löfgren’s syndrome was unlikely since he had no respiratory symptoms. He had normal full blood count and erythrocyte sedimentation rate (6 mm/h). C-reactive protein was raised (131 mg/L; reference range
