Tuberculous rheumatism: A great mimic of juvenile idiopathic arthritis

Abstract

Tuberculosis (TB) is an underreported epidemic. Musculoskeletal TB is a relatively rare extrapulmonary complication of Mycobacterium tuberculosis involving just 1%–3% of patients. It commonly affects the spine and osteoarticular joints such as hip and knee, and it is mostly monoarticular. Oligo and polyarticular involvement, also called tuberculous rheumatism or Poncet's disease (PD), is an extremely rare occurrence due to a vigorous immune response to mycobacteria which contributes to the arthritic process. Here, we report a case of PD in a 3-year-old girl, who presented with complaints of insidious onset polyarthritis, mimicking juvenile arthritis. Cervical lymph node aspirate isolated acid-fast bacilli. The child was diagnosed as a case of PD, and after starting antituberculous therapy, her symptoms dramatically resolved. This patient illustrates the need to consider the possibility of TB in high-risk pediatric populations in countries like India as one of the causes of nonresolving chronic arthritis.

Keywords

• Extrapulmonary tuberculosis
• juvenile idiopathic arthritis
• polyarthritis
• Poncet's disease
• tuberculous rheumatism