{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T12:07:26Z","timestamp":1784549246278,"version":"3.55.0"},"reference-count":17,"publisher":"FapUNIFESP (SciELO)","license":[{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"am","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001807","name":"FAPESP","doi-asserted-by":"crossref","award":["2022\/12925-8"],"award-info":[{"award-number":["2022\/12925-8"]}],"id":[{"id":"10.13039\/501100001807","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100001807","name":"FAPESP","doi-asserted-by":"crossref","award":["304984\/2020-5"],"award-info":[{"award-number":["304984\/2020-5"]}],"id":[{"id":"10.13039\/501100001807","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100003593","name":"CNPq","doi-asserted-by":"crossref","award":["2022\/12925-8"],"award-info":[{"award-number":["2022\/12925-8"]}],"id":[{"id":"10.13039\/501100003593","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100003593","name":"CNPq","doi-asserted-by":"crossref","award":["304984\/2020-5"],"award-info":[{"award-number":["304984\/2020-5"]}],"id":[{"id":"10.13039\/501100003593","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Rev. Inst. Med. trop. S. Paulo"],"abstract":"<jats:p>Disseminated tuberculosis in children may present with systemic and immunologic features that overlap with autoimmune diseases, complicating diagnosis and treatment. We report the first pediatric case of microbiologically confirmed disseminated tuberculosis involving multiple sites associated with Poncet's disease, mimicking childhood-onset systemic lupus erythematosus (cSLE). A previously healthy five-year-old boy presented with a four-month history of persistent fever, weight loss, and symmetrical oligoarthritis involving both knees and wrists, resulting in loss of mobility. Laboratory tests revealed severe non-hemolytic anemia, leukopenia, elevated inflammatory markers, hypoalbuminemia, hematuria, positive antinuclear antibodies, low complement levels, and lupus anticoagulant positivity. Chest imaging showed bilateral pleural effusion, pulmonary opacities, and lymphadenopathy, fulfilling the Systemic Lupus International Collaborating Clinics (SLICC) classification criteria for cSLE. Despite initially negative tuberculin skin test and gastric lavage analysis, lymph node biopsy confirmed Mycobacterium tuberculosis by histology, molecular assay, and culture. Subsequent urine and gastric samples were also positive. The patient had received BCG vaccination at birth. He was treated with rifampicin, isoniazid, pyrazinamide, and pyridoxine, with rapid clinical improvement, complete resolution of arthritis, and full recovery of mobility without sequelae in one month. No immunosuppressive therapy was administered. This case reinforces the diagnostic complexity of distinguishing tuberculosis from childhood-onset systemic autoimmune rheumatic diseases, particularly in endemic regions. To our knowledge, this is the first reported pediatric case of disseminated tuberculosis with Poncet's disease mimicking cSLE. Recognizing this specific condition is crucial to prevent misdiagnosis and unnecessary immunosuppression, while ensuring timely treatment of the underlying infection.<\/jats:p>","DOI":"10.1590\/s1678-9946202668043","type":"journal-article","created":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T11:34:20Z","timestamp":1784547260000},"source":"Crossref","is-referenced-by-count":0,"title":["Disseminated tuberculosis with Poncet's disease mimicking childhood-onset systemic lupus erythematosus: a unique case report"],"prefix":"10.1590","volume":"68","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-5430-0088","authenticated-orcid":false,"given":"Matheus Santos","family":"Fran\u00e7a","sequence":"first","affiliation":[{"name":"Instituto da Crian\u00e7a e do Adolescente,  Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7616-9898","authenticated-orcid":false,"given":"Fernanda Lima","family":"Gomes","sequence":"additional","affiliation":[{"name":"Instituto da Crian\u00e7a e do Adolescente,  Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-8689-8715","authenticated-orcid":false,"given":"Marina de Azambuja","family":"Nogueira","sequence":"additional","affiliation":[{"name":"Instituto da Crian\u00e7a e do Adolescente,  Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8844-8245","authenticated-orcid":false,"given":"Maria Fernanda B\u00e1due","family":"Pereira","sequence":"additional","affiliation":[{"name":"Instituto da Crian\u00e7a e do Adolescente,  Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0940-7793","authenticated-orcid":false,"given":"Heloisa Helena de Sousa","family":"Marques","sequence":"additional","affiliation":[{"name":"Instituto da Crian\u00e7a e do Adolescente,  Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8743-7827","authenticated-orcid":false,"given":"Katia Tomie","family":"Kozu","sequence":"additional","affiliation":[{"name":"Instituto da Crian\u00e7a e do Adolescente,  Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9653-0468","authenticated-orcid":false,"given":"Lucia Maria Arruda","family":"Campos","sequence":"additional","affiliation":[{"name":"Instituto da Crian\u00e7a e do Adolescente,  Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9250-6508","authenticated-orcid":false,"given":"Clovis Artur","family":"Silva","sequence":"additional","affiliation":[{"name":"Instituto da Crian\u00e7a e do Adolescente,  Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"530","published-online":{"date-parts":[[2026]]},"reference":[{"key":"ref1","series-title":"Global tuberculosis report 2024","year":"2024"},{"key":"ref2","series-title":"Tuberculose 2025. Bol Epidemiol","first-page":"1","year":"2025"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"e898","DOI":"10.1016\/S2214-109X(17)30289-9","article-title":"The global burden of tuberculosis mortality in children: a mathematical modelling study","volume":"5","author":"Dodd PJ","year":"2017","journal-title":"Lancet Glob Health"},{"key":"ref4","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1136\/archdischild-2018-315453","article-title":"Alternative sputum collection methods for diagnosis of childhood intrathoracic tuberculosis: a systematic literature review","volume":"104","author":"Ioos V","year":"2019","journal-title":"Arch Dis Child"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"389","DOI":"10.3390\/pathogens11040389","article-title":"Diagnostic advances in childhood tuberculosis: improving specimen collection and yield of microbiological diagnosis for intrathoracic tuberculosis","volume":"11","author":"Wobudeya E","year":"2022","journal-title":"Pathogens"},{"key":"ref6","series-title":"WHO operational handbook on tuberculosis: module 5: management of tuberculosis in children and adolescents","year":"2022"},{"key":"ref7","article-title":"Tuberculosis in infants and children","volume":"5","author":"Lamb GS","year":"2017","journal-title":"Microbiol Spectr"},{"key":"ref8","series-title":"Manual de recomenda\u00e7\u00f5es para o controle da tuberculose no Brasil","year":"2019","edition":"2\u00aa ed. atual."},{"key":"ref9","doi-asserted-by":"crossref","first-page":"e1307","DOI":"10.1016\/S2214-109X(22)00283-2","article-title":"Infant BCG vaccination and risk of pulmonary and extrapulmonary tuberculosis throughout the life course: a systematic review and individual participant data meta-analysis","volume":"10","author":"Martinez L","year":"2022","journal-title":"Lancet Glob Health"},{"issue":"Suppl 3","key":"ref10","doi-asserted-by":"crossref","first-page":"S184","DOI":"10.1086\/651490","article-title":"Pediatric tuberculosis: global overview and challenges","volume":"50","author":"Swaminathan S","year":"2010","journal-title":"Clin Infect Dis"},{"key":"ref11","doi-asserted-by":"crossref","first-page":"102057","DOI":"10.1016\/j.berh.2025.102057","article-title":"Musculoskeletal manifestations in tuberculosis","volume":"39","author":"Subramanian R","year":"2025","journal-title":"Best Pract Res Clin Rheumatol"},{"key":"ref12","first-page":"839","article-title":"Tuberculous rheumatism","volume":"16","author":"Brav EA","year":"1934","journal-title":"J Bone Joint Surg"},{"key":"ref13","first-page":"732","article-title":"De la polyarthrite tuberculeuse d\u00e9formante ou pseudo-rheumatisme chronique tuberculeux","volume":"2","author":"Poncet A","year":"1897","journal-title":"Congr Fr Chir"},{"key":"ref14","doi-asserted-by":"crossref","first-page":"929","DOI":"10.1007\/s10067-013-2270-y","article-title":"Clinical features of Poncet's disease: description of 198 cases found in the literature","volume":"32","author":"Rueda JC","year":"2013","journal-title":"Clin Rheumatol"},{"key":"ref15","doi-asserted-by":"crossref","first-page":"1010","DOI":"10.1111\/1756-185X.12726","article-title":"A case series and review of Poncet's disease, and the utility of current diagnostic criteria","volume":"19","author":"Sharma A","year":"2016","journal-title":"Int J Rheum Dis"},{"key":"ref16","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1210\/er.2016-1070","article-title":"Vitamin D-mediated hypercalcemia: mechanisms, diagnosis, and treatment","volume":"37","author":"Tebben PJ","year":"2016","journal-title":"Endocr Rev"},{"key":"ref17","doi-asserted-by":"crossref","first-page":"2677","DOI":"10.1002\/art.34473","article-title":"Derivation and validation of the Systemic Lupus International Collaborating Clinics classification criteria for systemic lupus erythematosus","volume":"64","author":"Petri M","year":"2012","journal-title":"Arthritis Rheum"}],"container-title":["Revista do Instituto de Medicina Tropical de S\u00e3o Paulo"],"original-title":[],"link":[{"URL":"http:\/\/www.scielo.br\/scielo.php?script=sci_pdf&pid=S0036-46652026000101008&tlng=en","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T11:34:24Z","timestamp":1784547264000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.scielo.br\/scielo.php?script=sci_arttext&pid=S0036-46652026000101008&tlng=en"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026]]},"references-count":17,"alternative-id":["S0036-46652026000101008"],"URL":"https:\/\/doi.org\/10.1590\/s1678-9946202668043","relation":{},"ISSN":["1678-9946"],"issn-type":[{"value":"1678-9946","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026]]},"article-number":"e43"}}