Disseminated Gonococcal Disease Presenting As Achilles Tenosynovitis: Story of a Diagnostic Challenge

The Disseminated Gonococcal Disease (DGI) presents with varying signs and symptoms such as arthralgias and skin lesions to less commonly tenosynovitis posing a diagnostic challenge. In this case, a 64-year-old male presented to the emergency department with a 2-day history of flu-like symptoms, burning with urination, left ankle pain, erythema, and swelling. He met Systemic Inflammatory Response Syndrome (SIRS) criteria and was treated for presumed viral syndrome with supportive care. Blood cultures later grew Neisseria gonorrhoeae. He was called back to the hospital and treated with IV ceftriaxone and oral doxycycline. Further questioning following his treatment revealed a social history significant for recent unprotected receptive oral intercourse with a male partner. This case highlights the importance of early risk stratification and a higher index of suspicion in keeping DGI in the differential diagnosis of tenosynovitis with fever.