BY 4.0 license Open Access Published by De Gruyter October 26, 2020

Gonococcal arthritis

Kyle Mills and Parth Jadav

A 53-year-old man with history of HIV presented with one day of left wrist and hand pain, swelling, and associated painful movement and tenderness to palpation. This progressed over several hours to include bilateral shoulder pain and right ankle pain that came in waves. Laboratory studies revealed white blood cell count of 22 × 103/µL, CK of 2,585 U/L and CRP of 158 mg/L. He denied dysuria, but endorsed subjective fever. He also reported unprotected receptive intercourse with an anonymous contact 1 week prior. MRI of the left wrist demonstrated effusion within the radiocarpal, distal radioulnar, and intercarpal joints (image A), as well as tenosynovial effusion suggestive of tenosynovitis of the extensor tendons (image B). Chlamydia trachomatis and Neisseria gonorrhoeae urinary testing were negative, but blood cultures grew Neisseria gonorrhoeae. A peripherally inserted central catheter line was placed and the patient was discharged to complete 4 weeks of ceftriaxone.

Gonococcal arthritis can occur secondary to hematogenous spread from bacteremia. Symptoms often include fevers, migratory arthralgias, and tenosynovitis. Clinical presentation, elevated inflammatory markers, leukocytosis, imaging, synovial fluid analysis, and blood cultures aid in the diagnosis. Antimicrobial therapy is the mainstay of treatment.2,3 (https://10.7556/jaoa.2020.144)


Corresponding author: Kyle Mills, DO, Department of Internal Medicine, The University of Louisville, 550 South Jackson St, 3rd Floor, Louisville, KY, 40202-1622, USA, E-mail:

References

1. Shirtliff, ME, Mader, JT. Acute septic arthritis. Clin Microbiol Rev. 2002;15(4):527-544. https://doi.org/10.1128/cmr.15.4.527-544.2002. Search in Google Scholar

2. Maharaj, R, Mody, GM. The rarity of gonococcal arthritis in association with HIV infection. J Infect Dev Ctries. 2014;8(9):1222-1227. https://doi.org/10.3855/jidc.4450. Search in Google Scholar

3. Haile, Z, Khatua, S. Beyond osteoarthritis: recognizing and treating infectious and other inflammatory arthropathies in your practice. Prim Care. 2010;37(4):713–vi. https://doi.org/10.1016/j.pop.2010.07.004. Search in Google Scholar

Received: 2020-07-17
Accepted: 2020-09-03
Published Online: 2020-10-26

© 2021 Kyle Mills and Parth Jadav, published by De Gruyter, Berlin/Boston

This work is licensed under the Creative Commons Attribution 4.0 International License.