Gonococcal Tenosynovitis With Abscess Formation: A Rare Presentation of Disseminated Infection

Gonococcal tenosynovitis is a rare but serious manifestation of disseminated Neisseria gonorrhoeae (N. gonorrhoeae) infection. It presents with localized inflammatory symptoms, including joint and tendon sheath involvement, and requires early recognition to prevent complications, including abscess formation, tendon rupture, and long-term functional impairment. We report the case of a 40-year-old male who developed progressive swelling, erythema, and pain in his left wrist over 20 days, without significant response to oral anti-inflammatory treatment. Laboratory tests showed marked leukocytosis and elevated C-reactive protein (CRP), and imaging confirmed tenosynovitis with abscess formation involving the extensor compartment. The patient underwent open surgical drainage and was started on empirical piperacillin/tazobactam and vancomycin, which were later de-escalated to ceftriaxone following confirmation of N. gonorrhoeae via Gram stain and culture. He reported recent unprotected sexual intercourse, one week prior to symptom onset. Postoperatively, the patient improved significantly, with complete resolution of infection and full recovery of wrist mobility. He was discharged with outpatient orthopedic follow-up. Disseminated gonococcal infection (DGI) is an uncommon complication of gonorrhea that can manifest with arthritis, tenosynovitis, or dermatitis. The presence of abscesses may indicate a more severe or aggressive disease course. Diagnosis requires clinical suspicion, supported by imaging and microbiological confirmation. Prompt surgical intervention, combined with targeted antibiotic therapy, is critical to prevent complications such as tendon rupture and chronic disability. This case highlights the importance of including gonococcal infection in the differential diagnosis of acute tenosynovitis, especially in sexually active individuals. It also underscores the need for multidisciplinary management and the pivotal role of primary care providers in early identification and timely referral to prevent adverse outcomes.