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First case report of disseminated gonococcal arthritis in Newfoundland and Labrador
Nessika Karsenti1, Matthew Nelder2, Jennifer LeMeissurier1,2
1Faculty of Medicine, Memorial University, St. John's, NL, Canada.
Abstract:
Introduction. Disseminated gonococcal infections (DGIs) are a rare but often debilitating complication of Neisseria gonorrhoeae infections. Often presenting as arthritis-dermatitis syndrome, true suppurative joint infections are an even more rare form of DGI. Here, we present the first known case of DGI in Newfoundland and Labrador in over 10 years. Case report. A 50-year-old man who is known to inject drugs with multiple housing and social challenges presented to the emergency department with a 2-day history of an isolated, painful, erythematous knee. After being assessed by orthopaedics and undergoing an operative debridement, intraoperative cultures grew N. gonorrhoeae. He was treated with intravenous ceftriaxone, and his course in hospital was complicated by inadequate pain control and a lack of stable housing. Conclusion. Although rare, DGIs need to remain on every clinician's differential for septic arthritis, given the increasing prevalence of gonorrhoeal infections in Canada, particularly in Newfoundland and Labrador. In addition, patients who are at risk of delaying accessing care, such as people who inject drugs and unhoused individuals, are at higher risk of complicated hospital stays.
Insights
Disseminated gonococcal infections (DGI) are rare but serious. This case highlights DGI presenting as septic arthritis in a person who injects drugs, emphasizing the need for vigilance in diagnosing gonorrhoea.
Area of Science:
- Infectious Diseases
- Rheumatology
- Public Health
Background:
- Disseminated gonococcal infections (DGI) are a rare complication of *Neisseria gonorrhoeae*.
- Septic arthritis is an even rarer manifestation of DGI.
- Increasing prevalence of gonococcal infections in Canada, including Newfoundland and Labrador.
Observation:
- A 50-year-old man who injects drugs presented with acute, isolated knee pain and erythema.
- Operative debridement revealed *Neisseria gonorrhoeae* in intraoperative cultures.
- The patient experienced a complicated hospital course due to pain management and housing instability.
Findings:
- This report details the first DGI case in Newfoundland and Labrador in over a decade.
- Successful treatment with intravenous ceftriaxone was initiated.
- The case underscores the link between DGI, septic arthritis, and specific patient demographics.
Implications:
- Clinicians should consider DGI in the differential diagnosis of septic arthritis, especially with rising gonococcal infection rates.
- Vulnerable populations, including people who inject drugs and the unhoused, face higher risks for complicated DGI presentations and hospital stays.
- Public health strategies must address the increasing burden of gonorrhoea and its severe complications.
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