Difficult to distinguish: tuberculous myositis with Ponce's arthritis

Abstract

A fundamental question when treating a 65-year-old man is whether he has one disease or two symptoms at the same time. He initially presented with symmetrical swelling of the hands and forearms, polyarthralgia and erythema of the face. The patient was born in India and lived in the United States for several decades. He had no history of trauma, insect bites, recent travel, or injections. At that time, rheumatological evaluation was positive for anti-nuclear antibody, anti-double-stranded DNA antibody, and anti-SSA/Ro antibody. I was diagnosed with systemic lupus erythematosus and started treatment with prednisone and methotrexate, then switched to hydroxychloroquine.