Disseminated Gonococcal Infection Presenting as an Isolated Rash in a Young Patient: A Case Report and Review of...

Neisseria gonorrhoeae (N. gonorrhoeae)is a Gram-negative diplococcus responsible for sexually transmitted infections (STIs) worldwide. While gonorrhea primarily affects mucosal surfaces, disseminated gonococcal infection (DGI) can occur, presenting with polyarthritis, tenosynovitis, and dermatitis. However, atypical presentations can delay diagnosis and treatment. Men who have sex with men (MSM) are commonly affected by gonorrhea, necessitating vigilance for DGI in this population. A 24-year-old MSM with a history of previously treated gonorrhea presented with a petechial rash on the lower extremities and mild, painless foot swelling without systemic symptoms or joint involvement. The patient had engaged in multiple unprotected sexual encounters in the preceding month. Physical examination revealed a non-itchy, non-blanching rash, most prominent on the dorsum of the feet and sparing the soles. Laboratory findings showed leukocytosis and pyuria, while bacterial cultures remained negative. Nucleic acid amplification testing (NAAT) from urine was positive for N. gonorrhoeae, confirming the diagnosis. Given the absence of joint symptoms, purulent arthritis was considered unlikely, and leukocytoclastic vasculitis (LCV) was a differential diagnosis. However, the patient demonstrated significant improvement with ceftriaxone and doxycycline, supporting DGI as the primary diagnosis. He completed a seven-day course of ceftriaxone and oral doxycycline with full resolution of symptoms at follow-up. This case highlights an unusual presentation of DGI with isolated dermatologic manifestations and no tenosynovitis or arthritis. Methamphetamine use, previously linked to increased susceptibility to DGI, was noted in this patient. Negative blood and mucosal cultures emphasize the role of NAAT in diagnosing atypical DGI. Comparative case reviews demonstrate a wide spectrum of DGI presentations, reinforcing the need for early recognition. Clinicians should maintain a high index of suspicion for DGI, particularly in at-risk populations such as MSM, even in the absence of classic symptoms. Prompt diagnosis using NAAT and early antibiotic initiation are crucial for preventing complications. This case underscores the need for heightened awareness of atypical presentations to optimize patient outcomes.