An 89-year-old male patient with no relevant past medical history presented with anorexia for a month and a half of evolution accompanied by swelling in hands and feet.
She reported an episode of rectal bleeding.
Physical examination revealed only limited edema associated with phalanological metaphases.
With the diagnosis of suspected RS3PE, treatment with prednisone 20 mg/24 hours was initiated, and the edema completely disappeared after 5 days of treatment.
Since this syndrome may appear associated with other pathologies, the patient was studied.
1.
Complementary tests showed Hb 10.3 g/dL, with MCV 94.5.
Biochemistry glucose, urea, creatinine, calcium total, phosphate, cholesterol, HDL-cholesterol, LDL-cholesterol, total proteins, GPT, LDH, GGT, Na, K were normal.
Pockets and normal folates
Normal beta-2-microglobulin.
The proteinogram showed a monoclonal band of IgA lambda.
C-reactive protein and ESR were normal.
Interleukin 6 was normal.
HIV serology was negative.
Rheumatoid factor, antinuclear antibodies and antineutrophil cytoplasmic antibodies were negative.
PSA was normal.
The HLA-B27 phenotype was positive.
Bence-Jones proteinuria was negative.
Pathologic examination was normal.
Radiographs of hands and feet showed no erosive lesions.
In the thoracic CT scan of the posterior segment of the LSD, a pulmonary infiltrate was observed, adopting a branched morphology (three non-budish-like) and nodular; in the LM there was also a nodular pleuroparetic tract with a branched morphology,
Abdominal CT urinary bladder with thickening of the bladder floor, with multiple diverticula, prostatic hypertrophy.
Bronchoscopy showed a trachea and left bronchial tree with chronic inflammatory signs. The most important were diverticula and plaques anthracosis throughout the bronchial tree. At the level of the right bronchial tree LM there was a friable entrance bronchial biopsy
The cytological study of the BAS revealed an acute inflammatory smear.
Löwestein's culture of the BAS was positive for Mycobacterium tuberculosis.
During the patient's evolution, it was observed that, 5 days after starting corticoid treatment, edema of the hands and feet disappeared, and the hemoglobin returned to normal one month later.
Four months after starting prednisone, Mycobacterium tuberculosis was identified and isoniazid, rifampicin and pyrazinamide were administered. Corticosteroid treatment was suspended due to the suspicion of Poncet's disease.
Three months after the onset of tuberculous meningitis and the withdrawal of corticosteroids, the swelling reappeared in hands and feet, so corticosteroid treatment was reintroduced.
