A Pain in the Hip: Sexually Transmitted Septic Arthritis Diagnosed With Bedside Ultrasound in the Emergency Department

TL;DR

A case report shows how a patient with a sexually transmitted infection developed septic arthritis, diagnosed using ultrasound in the emergency department.

Contribution

Highlights the rapid onset of gonococcal septic arthritis despite prior negative STI tests and emphasizes the importance of a broad differential diagnosis.

Findings

Gonococcal septic arthritis can develop quickly despite recent negative STI test results.

Bedside ultrasound in the emergency department aided in the diagnosis of septic arthritis.

A broad differential diagnosis is crucial for timely and accurate identification of gonococcal septic arthritis.

Abstract

Disseminated gonococcal infection (DGI) is a recognized but uncommon complication of a sexually transmitted infection (STI). Some physicians and advanced practice providers may have a misunderstanding of the onset of DGI and think of it as a later manifestation of a gonococcal infection similar to syphilis, another common sexually transmitted infection. This is a case report of a patient tested for STIs 16 days prior to his presentation with negative results. However, he presented to the emergency department again with right hip pain one day after being seen for a urinary tract infection. Despite the short amount of time between negative test results and repeat emergency department visits, keeping a broad differential diagnosis allowed for the correct diagnosis to be made. This case report provides a better understanding of the onset of gonococcal septic arthritis, discusses the proper workup, differences in treatment compared to some other causes of septic arthritis, and the likely prognosis of gonococcal septic arthritis.

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