A case of Poncet disease diagnosed with interferon-gamma-release assays.
BACKGROUND
A 55-year-old, HLA-B27-positive Finnish woman presented with migratory, sterile polyarthritis.


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


METHODS
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.


RESULTS
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.
Division of Rheumatology, Department of Medicine, Helsinki University Central Hospital, P.O. Box 263, Helsinki, FIN-00029 HUS, Finland. heikki.valleala@hus.fi
Heikki
H
Valleala
Tamara
T
Tuuminen
Heikki
H
Repo
Kari K
KK
Eklund
Marjatta
M
Leirisalo-Repo
D016918:Arthritis, Reactive / Q000097:blood / Q000175:diagnosis*; D003937:Diagnosis, Differential; D004797:Enzyme-Linked Immunosorbent Assay / Q000379:methods*; D005260:Female; D006801:Humans; D007371:Interferon-gamma / Q000378:metabolism*; D008875:Middle Aged; D013582:Synovial Fluid / Q000378:metabolism*; D014057:Tomography, X-Ray Computed; D014397:Tuberculosis, Pulmonary / Q000097:blood / Q000175:diagnosis*
D007371:Interferon-gamma