Authors
Krishna Suresh, Anna Sunny, Nirmal Muthukumarasamy
Published in
South Dakota medicine : the journal of the South Dakota State Medical Association. Volume 79. Issue suppl 5. Pages s45.
Abstract
Disseminated gonococcal infection (DGI) is an uncommon but serious complication of untreated Neisseria gonorrhoeae infection, which typically presents as either the classic dermatitis-tenosynovitis-migratory polyarthralgia syndrome or as septic arthritis. Diagnosis is often challenging because blood and synovial cultures are frequently negative.
A 35-year-old male with past medical history of recurrent diverticulitis and syphilis, presented with arthritis involving the left knee and ankle, followed by a progressive rash starting on the palms and soles and spreading towards his trunk during a diverticulitis flare. History was notable for multiple sexual partners. Physical examination was significant for multiple skin lesions with variable morphology involving the palms and soles. Left knee joint exam revealed swelling and reduced range of motion. Labs showed elevated inflammatory markers, and reactive RPR of 1:32 with positive treponemal antibodies. Infective workup, including blood cultures, urine Chlamydia/gonorrhea NAAT were negative. Subsequent arthrocentesis of the left knee and left ankle revealed elevated nucleated cells (73,500/µl ankle, 76,250/µl knee) with positive monosodium urate crystals. Notably, broad range synovial PCR was positive for N. gonorrhea but joint cultures negative. He was diagnosed with DGI, and started on IV Ceftriaxone, and received IM Benzathine penicillin G weekly for 3 weeks for concurrent secondary syphilis.
This case underscores the diagnostic value of targeted molecular testing in DGI, when urine NAAT and cultures are often negative. Since mucosal gonococcal infections are frequently asymptomatic or may have cleared before dissemination, urogenital testing alone may be misleading. Concurrent rash with stable RPR titers and history of prior syphilis raised concern for active secondary infection. This reinforces the need for comprehensive STI screening in all patients with DGI. Lastly, presence of monosodium urate crystals does not exclude septic arthritis. Clinicians should maintain suspicion for DGI in sexually active patients presenting with fever, rash, and arthritis despite initially negative screening tests.
PMID:
42526016
Bibliographic data and abstract were imported from PubMed on 30 Jul 2026.
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