# 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.

## Key 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.