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Arthritis-Dermatitis Syndrome: a Case of Disseminated Gonococcal Infection with Petechial Skin Rash.

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Disseminated gonococcal infection (DGI) can present with unusual skin rashes. Prompt, extended parenteral cephalosporin treatment is crucial for DGI, especially when antibiotic susceptibility is unknown.

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Area of Science:

  • Infectious Diseases
  • Dermatology
  • Microbiology

Background:

  • Disseminated gonococcal infection (DGI) is a systemic complication of Neisseria gonorrhoeae.
  • Typical DGI manifestations include tenosynovitis, dermatitis, and migratory polyarthralgias.
  • Atypical presentations, such as specific cutaneous findings, can delay diagnosis.

Observation:

  • A 36-year-old woman presented with vaginal discharge, ankle pain, and a lower extremity rash post-intercourse.
  • Physical examination revealed petechial and purpuric rash on lower extremities and tenosynovitis.
  • Urine nucleic acid amplification test (NAAT) confirmed Neisseria gonorrhoeae, indicating DGI.

Findings:

  • The patient initially received oral azithromycin and intravenous ceftriaxone but was discharged early on oral therapy.
  • She returned with treatment-failure DGI and was subsequently treated with a 7-day course of intramuscular ceftriaxone.
  • Repeat urine NAAT was negative, and the patient resolved.

Implications:

  • This case highlights an atypical, painless petechial and purpuric rash as a manifestation of DGI.
  • It underscores the importance of a 7-day parenteral cephalosporin regimen for DGI treatment, particularly when antibiotic susceptibility data is unavailable.
  • Effective management of DGI requires timely diagnosis and appropriate, extended antibiotic therapy.