# First case report of disseminated gonococcal arthritis in Newfoundland and Labrador

## TL;DR

This paper reports the first case of disseminated gonococcal arthritis in Newfoundland and Labrador in over a decade, highlighting the condition's rarity and challenges in vulnerable populations.

## Contribution

The first documented case of disseminated gonococcal infection in Newfoundland and Labrador in over 10 years.

## Key findings

- A 50-year-old man with a history of drug injection and housing instability presented with gonococcal arthritis.
- Intraoperative cultures confirmed Neisseria gonorrhoeae as the causative agent.
- The patient's hospital stay was complicated by inadequate pain control and lack of stable housing.

## Abstract

Introduction. Disseminated gonococcal infections (DGIs) are a rare but often debilitating complication of Neisseria gonorrhoeae infections. Often presenting as arthritis–dermatitis syndrome, true suppurative joint infections are an even more rare form of DGI. Here, we present the first known case of DGI in Newfoundland and Labrador in over 10 years.

Case report. A 50-year-old man who is known to inject drugs with multiple housing and social challenges presented to the emergency department with a 2-day history of an isolated, painful, erythematous knee. After being assessed by orthopaedics and undergoing an operative debridement, intraoperative cultures grew N. gonorrhoeae. He was treated with intravenous ceftriaxone, and his course in hospital was complicated by inadequate pain control and a lack of stable housing.

Conclusion. Although rare, DGIs need to remain on every clinician’s differential for septic arthritis, given the increasing prevalence of gonorrhoeal infections in Canada, particularly in Newfoundland and Labrador. In addition, patients who are at risk of delaying accessing care, such as people who inject drugs and unhoused individuals, are at higher risk of complicated hospital stays.