Disseminated gonococcal infection - a case report.
ESC Congress Library. Barros M. 05/28/14; 50645; A-230
Mónica Barros
Mónica Barros
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Abstract
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Introduction: Disseminated gonococcal infection results from bacteremia caused by Neisseria gonorrhoeae, and occurs in 0.5-3 % of patients infected with this bacteria, transmitted by sexual contact.  It can lead to a variety of clinical symptoms and signs, such as dermatitis, polyarthralgias, tenosynovitis and fever. We present a clinical case of this rare condition, whose rapid resolution depended on the appropriate therapeutic institution.


Case report: 42 years-old female patient, with irrelevant history with exception of skin reaction in childhood after penicillin administration. She complained of atypical vaginal discharge for three months, resistant to topical therapy with metronidazole and dequalinium chloride, and oral therapy with fluconazole and tinidazole; associated with malaise and dermatitis for the last four days. After presenting with asymmetrical arthralgias and erythema nodosum and Neisseria gonorrhoeae being isolated in a cultural vaginal specimen, she initiated antibiotherapy. As she refused hospitalization she did the treatment, a single oral dose of 1g of azithromycin and daily intravenous ceftriaxone 1g, on an outpatient basis. Three days later, the patient was admitted to hospital because of persisting arthralgias, dermatitis, and fever onset. At this time she presented no vaginal discharge and the screening for other STDs (B and C hepatitis, HIV, and syphilis) was negative. She completed seven days of ceftriaxone (1g/day), with rapid clinical and analytic recovery (C-reactive-protein decreased from 257 mg /L 108mg/L)


Conclusion: Although rare, a disseminated gonococcal infection should be considered in the differential diagnosis of a patient presenting with arthralgias, cutaneous lesions and suspicious cervical-vaginal infection.


Introduction: Disseminated gonococcal infection results from bacteremia caused by Neisseria gonorrhoeae, and occurs in 0.5-3 % of patients infected with this bacteria, transmitted by sexual contact.  It can lead to a variety of clinical symptoms and signs, such as dermatitis, polyarthralgias, tenosynovitis and fever. We present a clinical case of this rare condition, whose rapid resolution depended on the appropriate therapeutic institution.


Case report: 42 years-old female patient, with irrelevant history with exception of skin reaction in childhood after penicillin administration. She complained of atypical vaginal discharge for three months, resistant to topical therapy with metronidazole and dequalinium chloride, and oral therapy with fluconazole and tinidazole; associated with malaise and dermatitis for the last four days. After presenting with asymmetrical arthralgias and erythema nodosum and Neisseria gonorrhoeae being isolated in a cultural vaginal specimen, she initiated antibiotherapy. As she refused hospitalization she did the treatment, a single oral dose of 1g of azithromycin and daily intravenous ceftriaxone 1g, on an outpatient basis. Three days later, the patient was admitted to hospital because of persisting arthralgias, dermatitis, and fever onset. At this time she presented no vaginal discharge and the screening for other STDs (B and C hepatitis, HIV, and syphilis) was negative. She completed seven days of ceftriaxone (1g/day), with rapid clinical and analytic recovery (C-reactive-protein decreased from 257 mg /L 108mg/L)


Conclusion: Although rare, a disseminated gonococcal infection should be considered in the differential diagnosis of a patient presenting with arthralgias, cutaneous lesions and suspicious cervical-vaginal infection.


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