title: A rare case of occult abdominal tuberculosis with Poncet's disease mimicking Adult onset Still's disease.
abstract: A 50-year-old female presented with fever, symmetrical arthralgias, rash, painful oral ulcerations and alopecia since 8 weeks. Examination showed mild hepatospleenomegaly. Investigations revealed leucocytosis, neutrophilia, elevated sedimentation rate and raised ferritin levels (3850 ng/ml). Computerized tomography (CT) abdomen showed hepatospleenomegaly, mild ascitis and mild bilateral pleural-effusion. After ruling out occult infections, tuberculosis, malignancies and autoimmune diseases by appropriate investigations, and due to raised ferritin levels, adult onset stills disease (AOSD) was diagnosed. Patient responded to oral steroids initially, but after 7 days developed severe abdominal pain. Repeat CT showed multiple enlarged, necrotic and matted retroperitoneal lymph nodes with caseating granuloma on histopathology suggesting tuberculosis. Patient was given four-drug anti-tubercular treatment and she improved. Thus our patient of occult abdominal tuberculosis with reactive arthritis (Poncet's disease) presented with hyperferritinemia mimicking AOSD. We postulate that extreme hyperferritinemia can be seen in tuberculosis and tuberculosis must be conclusively ruled out before diagnosing AOSD in tropics.
authors.affiliation: Department of Medicine, Dr. Sampurnanand Medical College, Jodhpur, Rajasthan, India.
authors.forename: Isha
authors.initials: I
authors.lastname: Sood
authors.affiliation: Department of Neurology, Dr. Sampurnanand Medical College, Jodhpur, Rajasthan, India.
authors.forename: Gaurav M
authors.initials: GM
authors.lastname: Kasundra
authors.affiliation: Department of Medicine, Dr. Sampurnanand Medical College, Jodhpur, Rajasthan, India.
authors.forename: Prathibha Shankaranarayana
authors.initials: PS
authors.lastname: Supriya
authors.affiliation: Department of Pathology, Bhagwan Mahavir Cancer Hospital and Research Centre, Jaipur, Rajasthan, India.
authors.forename: Aradhana
authors.initials: A
authors.lastname: Gupta
authors.affiliation: Department of Neurology, Dr. Sampurnanand Medical College, Jodhpur, Rajasthan, India.
authors.forename: Bharat
authors.initials: B
authors.lastname: Bhushan
keywords: Abdominal tuberculosis; adult onset stills disease; serum ferritin; serum ferritin levels