Recurrent disseminated gonococcal infection in a patient with hypocomplementemia and membranoproliferative...

We describe a patient with three documented episodes of disseminated gonococcal infection in an 18-month period. Gonococcal dissemination is relatively uncommon and recurrence is rare in the absence of a complement deficiency because most Neisseria gonorrhoeae strains are susceptible to complement-mediated killing by serum. Our patient was hypocomplementemic and had previously been diagnosed with type I membranoproliferative glomerulonephritis (MPGN), a presently untreatable form of renal disease that is associated with excessive complement consumption due either to activation of the classical pathway by immune complexes or to the action of "nephritic factors" that block the regulators of C3 convertase activity. We believe it is likely that MPGN-associated hypocomplementemia reduced this patient's serum bactericidal activity, permitting gonococcal dissemination on multiple occasions after local reinfection. In view of the potential for more serious Neisserial infection, antibiotic prophylaxis was considered, but the patient was lost to follow-up before it could be instituted.