Adult Gonococcal Conjunctivitis Complicated by Peripheral Ulcerative Keratitis: A Case Report

Neisseria gonorrhoeae conjunctivitis is rare in adults but may rapidly progress to vision-threatening complications. Peripheral ulcerative keratitis (PUK) is an unusual and severe manifestation. A 42-year-old male presented with bilateral ocular pain, swelling, and profuse purulent discharge for 15 days, leading to inability to open his eyes. History revealed recent urethral discharge and multiple sexual contacts. Ocular examination showed severe conjunctival chemosis and peripheral corneal thinning with descemetocele formation. Gram stain of conjunctival swabs demonstrated intracellular gram-negative diplococci. Serology revealed positive VDRL and TPHA (late latent syphilis). HIV and Chlamydia trachomatis testing were unavailable. The patient received intravenous ceftriaxone 1 g twice daily, oral doxycycline, and topical fortified antibiotics. Due to progressive corneal thinning, bilateral amniotic membrane grafting with perilimbal conjunctival excision and bandage contact lens placement was performed. Syphilis was treated with three weekly doses of benzathine penicillin G. At 6 weeks, vision improved to 6/9 bilaterally with healed ulcers and clear corneas. Gonococcal conjunctivitis in adults can rapidly progress to peripheral ulcerative keratitis. Early diagnosis, broad STI screening, systemic therapy, and timely surgical intervention are critical for preserving vision.