Gonococcal Septic Arthritis Involving Bilateral Wrists and Hands in an Elderly Patient

TL;DR

An elderly man developed a rare form of gonococcal infection affecting his wrists and hands, highlighting the challenges in diagnosing this condition.

Contribution

This case report presents a unique clinical presentation of disseminated gonococcal infection in an elderly patient with bilateral wrist involvement.

Findings

The patient presented with sudden bilateral wrist pain and swelling due to disseminated gonococcal infection.

Diagnosis was challenging due to multiple unsuccessful arthrocentesis attempts but was confirmed via tissue culture.

The patient was successfully treated with ceftriaxone.

Abstract

Neisseria gonorrhoeae (N. gonorrhoeae) is a Gram-negative intracellular diplococcus that is commonly spread via sexual activity. The bacteremic spread of gonorrhoeae can lead to an uncommon complication called disseminated gonococcal infection (DGI). DGI has a range of clinical presentations, some of which are vague and nonspecific, including polyarthralgias, isolated septic arthritis, and systemic symptoms. Septic arthritis is a painful joint infection that can lead to inflammation, swelling, and limited mobility. We discuss a case of a male in his mid-70s with sudden bilateral wrist pain and swelling due to a DGI. The diagnosis was complicated by multiple unsuccessful arthrocentesis attempts ("dry taps") but was eventually confirmed by tissue culture, and the patient was treated with ceftriaxone. This report highlights a unique clinical presentation of DGI, the complex nature of its diagnosis, and the importance of thorough history taking.

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