Disseminated Neisseria gonorrhea of the wrist

Area of Science:

• Infectious Diseases
• Rheumatology
• Public Health

Background:

• Disseminated gonococcal infection (DGI) is a rare complication of Neisseria gonorrhoeae, affecting 0.5-3% of infected individuals.
• DGI typically presents with mucosal involvement, septic arthritis, and potential bacteremia.
• Early diagnosis and treatment are crucial to prevent joint damage and systemic spread.

Observation:

• A 62-year-old female with a history of HIV and rheumatoid arthritis presented with DGI and septic arthritis of the right wrist.
• Notably, the patient lacked typical mucosal involvement or systemic symptoms at presentation.
• This atypical presentation highlights the diverse clinical manifestations of DGI.

Findings:

• The patient underwent surgical intervention, including incision and drainage with arthrotomy of the affected wrist.
• A 2-week course of intravenous ceftriaxone was administered as antibiotic treatment.
• Post-treatment, the patient showed significant symptom improvement and remained asymptomatic during follow-up.

Implications:

• This case underscores the importance of considering DGI in patients with septic arthritis, even in the absence of classic symptoms.
• Effective management involves a combination of surgical intervention and appropriate antibiotic therapy.
• Further research may elucidate risk factors and optimal treatment strategies for atypical DGI presentations, particularly in immunocompromised individuals.