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Gonococcal arthritis

  • Kyle Mills EMAIL logo and Parth Jadav
Published/Copyright: October 26, 2020
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Journal of Osteopathic Medicine
From the journal Journal of Osteopathic Medicine Volume 121 Issue 2

A 53-year-old man with history of HIV presented with one day of left wrist and hand pain, swelling, and associated painful movement and tenderness to palpation. This progressed over several hours to include bilateral shoulder pain and right ankle pain that came in waves. Laboratory studies revealed white blood cell count of 22 × 103/µL, CK of 2,585 U/L and CRP of 158 mg/L. He denied dysuria, but endorsed subjective fever. He also reported unprotected receptive intercourse with an anonymous contact 1 week prior. MRI of the left wrist demonstrated effusion within the radiocarpal, distal radioulnar, and intercarpal joints (image A), as well as tenosynovial effusion suggestive of tenosynovitis of the extensor tendons (image B). Chlamydia trachomatis and Neisseria gonorrhoeae urinary testing were negative, but blood cultures grew Neisseria gonorrhoeae. A peripherally inserted central catheter line was placed and the patient was discharged to complete 4 weeks of ceftriaxone.

Gonococcal arthritis can occur secondary to hematogenous spread from bacteremia. Symptoms often include fevers, migratory arthralgias, and tenosynovitis. Clinical presentation, elevated inflammatory markers, leukocytosis, imaging, synovial fluid analysis, and blood cultures aid in the diagnosis. Antimicrobial therapy is the mainstay of treatment.2,3 (https://10.7556/jaoa.2020.144)

Corresponding author: Kyle Mills, DO, Department of Internal Medicine, The University of Louisville, 550 South Jackson St, 3rd Floor, Louisville, KY, 40202-1622, USA, E-mail:

References

1. Shirtliff, ME, Mader, JT. Acute septic arthritis. Clin Microbiol Rev. 2002;15(4):527-544. https://doi.org/10.1128/cmr.15.4.527-544.2002.10.1128/CMR.15.4.527-544.2002Search in Google Scholar PubMed PubMed Central

2. Maharaj, R, Mody, GM. The rarity of gonococcal arthritis in association with HIV infection. J Infect Dev Ctries. 2014;8(9):1222-1227. https://doi.org/10.3855/jidc.4450.10.3855/jidc.4450Search in Google Scholar PubMed

3. Haile, Z, Khatua, S. Beyond osteoarthritis: recognizing and treating infectious and other inflammatory arthropathies in your practice. Prim Care. 2010;37(4):713–vi. https://doi.org/10.1016/j.pop.2010.07.004.10.1016/j.pop.2010.07.004Search in Google Scholar PubMed

Received: 2020-07-17
Accepted: 2020-09-03
Published Online: 2020-10-26

© 2021 Kyle Mills and Parth Jadav, published by De Gruyter, Berlin/Boston

This work is licensed under the Creative Commons Attribution 4.0 International License.

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https://doi.org/10.7556/jaoa.2020.144
Creative Commons
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Articles in the same Issue

  1. Frontmatter
  2. Editorial
  3. The language of race and ethnicity in academic medical publishing
  4. Behavioral Health
  5. Original Article
  6. Associations between stress, anxiety, depression, and emotional intelligence among osteopathic medical students
  7. Cardiopulmonary Medicine
  8. Clinical Practice
  9. Straight back syndrome as a clue to diagnosing asymptomatic congenital valvular heart disease and limiting the risk of weightlifting
  10. Innovations
  11. Review Article
  12. Toward the use of medical scent detection dogs for COVID-19 screening
  13. Medical Education
  14. Original Article
  15. Osteopathic students and graduates matching into pathology residency, 2011–2020
  16. Medical Education
  17. Special Communication
  18. Diversity in osteopathic medical school admissions and the COMPASS program
  19. Medical Education
  20. Commentary
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  22. Musculoskeletal Medicine and Pain
  23. Original Article
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  25. Neuromusculoskeletal Medicine (OMT)
  26. Review Article
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  28. Obstetrics and Gynecology
  29. Original Article
  30. Untangling the roots of the West Virginia opioid crisis: relationships in adolescent pregnancy, drug misuse, and future outcomes
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  43. Clinical Images
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  45. Gonococcal arthritis
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