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Background Poncet’s disease is a reactive polyarthritis associated to active tuberculosis with excluded presence of mycobacterium in the joints and bones affected; it is an infrequent form of tuberculosis and challenging diagnosis condition with unknown pathogenesis. We report a case of Poncet’s disease in Moroccan patient to contribute data which could result in a consensus of clinical criteria. Case report A 38-year-old female was admitted to the Rheumatology Department, Hassan II University Hospital as she presented with morning stiffness, arthralgias, symmetric arthritis of the wrists, ankles, bilateral sacroiliitis, enthesitis and inflammatory back pain. The patient had cervical lymphadenopathy with fever and erythema nodosum. Laboratory results were as follows: ESR 25 mm/h and C-reactive protein 13 mg/L while anti-nuclear antibodies, rheumatoid factor, human immunodeficiency virus and angiotensin converting enzyme were negative. The intradermal skin test for tuberculosis reading was 20 mm which is considered strongly positive. Histological report of cervical node tissue revealed granulomatous lesions compatible with tuberculosis. No alteration was observed in the radiographies of chest and the affected joints. MRI of sacroiliac joint and spine was normal. Spondyloarthritis and rheumatoid arthritis were ruled out. Therapy with pyrazinamide, isoniazide and rifampicin was started after which the arthritis resolved in a few days. The diagnosis of Poncet’s disease was confirmed. Conclusion The differential diagnosis between Poncet’s disease and autoimmune inflammatory joint diseases is a clinical challenge. However, Poncet’s disease should be considered as a differential diagnosis for patients with fever and arthritis of unknown cause, particularly if active tuberculosis is suspected. [ABSTRACT FROM AUTHOR]

Introduction Multifocal tuberculosis is an uncommon presentation in immune-competent patients; it’s associated more with an immune-depression like HIV (Human Immunodeficiency Virus) infection. Here, we are presenting unusual multifocal osteoarticular localizations including the wrist and tarsal joint which are rare and pleura-pulmonary tuberculosis. Case presentation Wrist, ankle, tarsal joint, hip and lung involvement was detected in a 30 year-old male patient. Mycobacterium tuberculosis was isolated from both synovial and pleural biopsy specimen cultures. The treatment was based on 9 months of antituberculosis drugs: rifampin (RMP), isoniazid (INH), pyrazinamide (Z) and ethambutol (EMB). INH (300 mg/day), RMP (600 mg/day), PZA (3gr/day) and EMB (1200 mg/day) were given for treatment 6 days/7. In the 4th week the patient’s condition improved and was discharged. After two months, the therapy was continued with INH and RMP up to 9 months. A hip replacement surgery and wrist Arthrodesis will be discussed after the patient’s total healing. Conclusion Tuberculous osteoarthritis is a frequently missed diagnosis, especially in different clinical patterns. A high level of suspicion is required particularly in high-risk populations and endemic areas. Well conducted treatment improves the prognosis. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: The osteochondromatosis is a rare synovial tissue metaplasia. The location at the shoulder is very rare. Bursal affection is exceptional. Case presentation: We report a case of a male, 41years old living in north Morocco and presenting to the rheumatology outpatient clinic at Fes Hassan II University Hospital with a swelling of the right shoulder that had been evolving for two years, without any history of trauma, gradually increasing in size, without fever or alteration of the general state. Clinical examination revealed a 5cm soft, non-tender oval mass on the anterior surface of the right shoulder with no signs of inflammation but limited range of motion. Plain X-ray was normal and diagnostic ultrasonography revealed an avascular multilocular cystic mass. A differential diagnosis was considered and other conditions with comparable pictures were ruled out. The diagnosis was confirmed by a magnetic resonance imaging showing synovitis and distension of the sub acromiodeltoid bursa with many rounded bodies, few millimeters in size of intermediate signal in T1 and T2 without enhancement after intravenous gadolinium. A diagnosis of osteochondromatosis of the subacromiodeltoid bursa (third stage) was made. The patient underwent an open bursectomy and histological examination further verified the diagnosis. Conclusion: Presenting such rare cases could help in raising the awareness of rheumatologists regarding such conditions when considering a differential diagnosis for patients presenting with monoarticluar shoulder swelling. Excision of the tumor has a remarkably better prognosis. [Copyright &y& Elsevier]

Abstract: Rheumatoid arthritis may be associated with an increased risk of hematological malignancy. Increased lympho-proliferative malignancy in rheumatoid arthritis is often described; however an increased risk of leukemia is not a common finding. A few cases of rheumatoid arthritis have been documented associated with chronic myeloid leukemia in the literature. We report a new case. Case presentation: A 36-year-old Moroccan female diagnosed as rheumatoid arthritis eight years ago, was on remission under Methotrexate and prednisone. This therapy was stopped one year before her admission at our hospital because of thrombopenia and anemia. She had polyarthritis flare. The physical examination found splenomegaly, hepatomegaly, and skin lesions at the trunk and limbs. Peripheral blood findings, peripheral smear and bone marrow aspiration diagnosed myeloid leukemia in a blastic accelerated phase with negative Philadelphia chromosome. The skin lesions were diagnosed as pyoderma gangrenosum (skin biopsy). She received oral prednisone and chemotherapy (Cytarabine and 6-Mercaptopurine). She had a complete response on the skin lesions, partial regression of splenomegaly, and improvement of her hematologic disorders. Unfortunately the patient died from septic shock after two weeks of post-chemotherapy pancytopenia. Conclusion: We report an unusual case of rheumatoid arthritis complicated by chronic myeloid leukemia associated with pyoderma gangrenosum. It is unclear whether the development of chronic myeloid leukemia in the patient with rheumatoid arthritis occurs by chance alone, is due to the underlying disease, or is facilitated by drugs. Whatever the cause is, it should be kept in mind that chronic myeloid leukemia may develop in the course of rheumatoid arthritis. [Copyright &y& Elsevier]

Abstract: Introduction: Cavernous hemangiomas are uncommon lesions and, as such, may enter the differential diagnosis of other lesions encountered more frequently in clinical practice, including pigmented villonodular synovitis and traumatic hemarthrosis. We report an illustrative case in a young patient in the Rheumatology Department of University Hospital of Fez in Morocco. Aim of the work: The aim of our work is: [–] To present to the reader this rare pathology. Of which the diagnosis can be late or misdiagnosed because of the non specificity of symptoms and the underestimation of this pathological entity. [–] To assess the contribution of magnetic resonance imaging (MRI) in the diagnosis and surgical planning of synovial hemangioma of the knee. Case report: A 19year old single Morrocan woman who presented a non specific chronic knee tumefaction secondary to cavernous angioma confirmed radiologically and histologically, with a good evolution after surgery. Conclusion: Cavernous hemangioma of the knee is a frequently misdiagnosed lesion. MRI is the exploration of choice for this vascular tumor of the synovial membrane, although a pathology study is needed to confirm the diagnosis. Early surgical treatment with excision of the tumor within wide margins of uninvolved normal synovial tissue as partial or total synovectomy is the therapy of choice. [Copyright &y& Elsevier]

Introduction Meniscal cysts are rare and usually asymptomatic. They may cause various symptoms depending upon their size and site of origin. It may present as a palpable mass with or without pain and sometimes grows large enough to limit the patient’s activities of daily living. The magnetic resonance imaging (MRI) is the gold standard for their visualization. Excision is often guided by a careful study of the pre-operative MRI scans in multiple planes. Case report We report an unusual case of a medial meniscal cyst of the knee in a 40-year-old Moroccan patient with a progressively increasing swelling of his left knee for 1 year. There was no history of trauma. On examination there was a tender effusion. The range of motion of the knee was limited 0–110°. The MRI showed a meniscal cyst extending around the medial collateral ligament into the soft tissue. The lateral meniscus, anterior cruciate, posterior cruciate and collateral ligaments were normal in appearance. The well-circumscribed cyst was excised and the diagnosis confirmed by the histopathology. At 1-year follow up, he had full range of knee movement and remained asymptomatic, with no sign of recurrence. Conclusion Medial meniscal cysts should be considered in any patient presenting with persistent medial knee discomfort. Rigorous history and physical examination are essential to identify similar rare presentations. The use of MRI is important in confirming such anomalies and plan surgical intervention. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Reflex sympathetic dystrophy (RSD) during pregnancy is a rare condition and may be misdiagnosed. We report a case of RSD involving the hip in a 22-year-old woman with onset during the third trimester of pregnancy. Case presentation: A 22-year-old Moroccan woman presented in the third trimester (34weeks of gestation) of her second pregnancy with permanent pain in the left hip that made standing and walking difficult. Physical examination of the hip showed mild painful range-of-motion restriction. Erythrocyte sedimentation rate was 40mm (1st hour) and C-reactive protein was 10mg/l. Ultrasound of the left hip was normal. Magnetic resonance imaging (MRI) revealed a characteristic image of RSD involving the left hip. Treatment was symptomatic, combining non-weight-bearing exercises with rest and analgesics (Paracetamol). Physical therapy was gradually undertaken and was carried out only to the point of pain. Clinical recovery was rapidly obtained (within 2weeks). Conclusion: Pregnancy is a potential cause of hip RSD. This diagnosis must be always kept in mind when attending a pregnant patient or a patient with hip pain and functional impairment. [Copyright &y& Elsevier]

Abstract: Background: Reactive arthritis is classified as an autoimmune condition that develops in response to an infection in another part of the body (cross-reactivity). Coming into contact with bacteria and developing an infection can trigger the disease. Case presentation: We describe a female patient, who presented with acute polyarthritis. Gynecological examination showed vaginal inflammation. Cultures from vaginal swabs grew Gardnerella vaginalis. The diagnosis of G. vaginalis induced reactive arthritis was posed. Treatment with Flagyl (500mg a day) was followed by a gradual reduction of the arthritis, and vaginal discharge. Conclusion: We propose to consider including Gardnerella infection among the causative factors of reactive arthritis and Reiter’s syndrome. [Copyright &y& Elsevier]