Typical case of Disseminated Gonococcal Infection reported

Dr Stephanie Florez-Pollack, at University of Texas Southwestern Medical Center, Dallas, TX and colleagues have reported a rare case of Disseminated Gonococcal Infection. The case has appeared in the New England Journal of Medicine.

Disseminated gonococcal infection (DGI) results from the bacteremic spread of the sexually transmitted pathogen, Neisseria gonorrhoeae, which can lead to a variety of clinical symptoms and signs, such as arthritis or arthralgias, tenosynovitis, and multiple skin lesions.

Disseminated gonococcal infection (DGI) is estimated to occur in 0.5 to 3 per cent of patients infected with N. gonorrhoeae. Most patients with DGI are younger than 40 years of age, although DGI can occur in any age group. Historically, DGI occurred more frequently in females than males; however, that sex ratio may be reversing, with increases in gonococcal infection in general among males, and because DGI might be more common among HIV-infected individuals (of whom males comprise the majority in North America and Western Europe

A 20-year-old woman presented to the emergency department with a rash involving the arms, legs, trunk, and scalp, which had erupted that morning. She also reported generalized muscle aches, fever, and pain in both ankles. Two weeks earlier, the patient had vaginal intercourse with a new partner without barrier protection.

The physical examination was notable for erythematous pustules near the wrist and on the fingers (Panel A) and on the trunk, scalp, and both ankles. There were mild swelling and pain with passive motion in the right ankle and tenosynovitis involving the tendons of both ankles. Given a high suspicion for disseminated gonococcal infection, treatment with ceftriaxone and azithromycin was initiated.

Courtesy NEJM

Blood cultures grew gram-negative diplococci (Panel B) that were identified as Neisseria gonorrhoeae, which confirmed the diagnosis. The patient’s symptoms abated with antibiotic treatment. At 3 months of follow-up, the patient was feeling well, with no recurrence of skin lesions or joint pain.