Polyarthritis and erythema nodosum: an unusual presentation of tuberculosis

Authors

  • Partisha Gupta Department of Internal Medicine, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India http://orcid.org/0000-0002-8783-5830
  • Aditya Dhanawat Department of Internal Medicine, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India http://orcid.org/0000-0003-1910-5841
  • Lalatendu Mohanty Department of Internal Medicine, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India http://orcid.org/0000-0001-5630-2735
  • Siddhartha Mishra Department of Internal Medicine, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India

DOI:

https://doi.org/10.18203/2349-3933.ijam20190129

Keywords:

Erythema nodosum, Polyarthritis, Tuberculous lymphadenitis

Abstract

Reactive arthritis and erythema nodosum occur in presence of active tubercular infection and both are immunological phenomenon. Author described a case report of a 17year old female with 10months history of symmetrical polyarthritis and presence of healed lesions of erythema nodosum. She was also found to have caseating granulomatous lesion in right supraclavicular lymph node which led us to diagnosis of tuberculous lymphadenitis presenting as reactive polyarthritis (poncet’s disease) and erythema nodosum. Her joint pain and swelling dramatically resolved after 2weeks of ATT. Thus, tuberculosis may manifest as reactive polyarthritis (poncet’s disease) and erythema nodosum and they should be kept in mind even in the absence of other clinical clues of TB, to provide patients with a good clinical outcome. 

References

Kritsotakis E. Erythema nodosum as sign of primary tuberculosis. Oxford Med Case Rep. 2017;2017(8):147-9.

Whig J, Mahajan V, Kashyap A, Gupta S. Erythema nodosum: atypical presentation of common disease. Lung Ind: Off Organ Ind Chest Soc. 2010;27(3):181.

Ideguchi H, Ohno S, Takase K, Tsukahara T, Kaneko T, Ishigatsubo Y. A case of Poncet’s disease (tuberculous rheumatism). Rheumatol Inter. 2009;29(9):1097-9.

Ottenhof T, Torres P, Terrencio A. HLA DR4+ associated immune response gene for mycobacterium tuberculosis: a clue to the pathogenesis of rheumatoid arthritis. Lancet. 1989;2:310-2.

Dall L, Long L, Stanford J. Poncet's disease: tuberculous rheumatism. Rev Inf Dis. 1989;11(1):105-7.

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. Lancet. 1986;328(8502):305-9.

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Published

2019-01-23