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A case of Poncet disease diagnosed with interferon-γ-release assays

Nature Reviews Rheumatology volume 5, pages 643–647 (2009)Cite this article

Abstract

Background. A 55-year-old, HLA-B27-positive Finnish woman presented with migratory, sterile polyarthritis.

Investigations. Physical examination, chest radiography, serologic testing, microscopy, M. tuberculosis-specific interferon γ enzyme-linked immunospot (ELISPOT) assay, smear and culture of synovial fluid for acid-fast bacilli, and PCR.

Diagnosis. The patient's assayed blood and synovial fluid lymphocytes were reactive, and the numbers of M. tuberculosis-specific T cells, as determined by ELISPOT, were twofold to sixfold higher in synovial fluid than in blood. Cultures for acid-fast bacilli remained negative, while PCR specific for DNA of the M. tuberculosis complex was positive in synovial fluid cells. These results suggested that the patient had either active or latent M. tuberculosis infection. This finding, coupled with the presence of polyarthritis, led to a diagnosis of Poncet disease.

Management. Standard antituberculous therapy consisting of isoniazid, rifampicin and pyrazinamide was given for 2 months, followed by isoniazid and rifampicin for 4 months. Inflamed joints were treated with methylprednisolone injections. The polyarthritis resolved within 4 months of initiating antituberculous therapy.

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Figure 1: CT of the chest.
Figure 2: Synovitis of the right metatarsophalangeal joints and dactylitis of the second and third toes of the right foot.
Figure 3: Ultrasonography of the left foot.

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Author information

Authors and Affiliations

  1. Division of Rheumatology, Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland

    Heikki Valleala, Heikki Repo, Kari K. Eklund & Marjatta Leirisalo-Repo

  2. Department of Bacteriology and Immunology, University of Helsinki, Helsinki, Finland

    Tamara Tuuminen

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  1. Heikki Valleala
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  2. Tamara Tuuminen
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Correspondence to Heikki Valleala.

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Valleala, H., Tuuminen, T., Repo, H. et al. A case of Poncet disease diagnosed with interferon-γ-release assays. Nat Rev Rheumatol 5, 643–647 (2009). https://doi.org/10.1038/nrrheum.2009.208

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