Described by Antonin Poncet in 1897, Poncet’s disease is a non-destructive (non-erosive) inflammatory arthritis secondary to a mycobacterial infection, without an identified infectious agent in the affected joints. Neuromeningeal localization of tuberculosis (TB) is rare but remains the most severe with hight mortality and permanent neurological damage. Association of Poncet’s rheumatism and TB is rare, even less a neuromeningeal localization. We report here a case of optic nerve compression syndrome complicating tuberculous meningitis associated with Poncet’s rheumatism characterized by a good outcome. This was an 18-year-old female with no reported pathological history, who was admitted for obnubilation. The symptoms started two weeks before her hospitalization and were marked by fever and headache. On admission, the examination revealed obnubilation, bilateral pyramidal deficit syndrome, right ptosis and areactive mydriasis predominating on the right, meningeal syndrome, and intense inflammatory polyarthralgia. The brain CT showed meningeal contrast enhancement with moderate dilatation of ventricles. GeneXpert MTB/rif in CSF was positive. Rheumatoid factors (latex and Waaler-Rose test) and anti-CCP antibodies were negative. Anti-nuclear, anti-native DNA and anti-NAS antibodies were negative. Ophthalmological examination revealed optic nerve compression syndrome associated with extrinsic and intrinsic oculomotor paralysis in the right eye. Orbito-encephalic MRI showed compression of the optic nerve, and hydrocephalus. Under antituberculosis treatment, we noticed disappearance of arthralgia in three weeks, regression of intracranial hypertension and improvement of vision.
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