SHM Converge Scientific Abstract ePoster Gallery-"It's Not Lupus": Disseminated Gonococcal Infection Masquerading as Autoimmune Flare

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This case describes a 17-year-old female with systemic lupus erythematosus (SLE) and lupus nephritis who developed weeks of migratory polyarthralgia, fevers, chills, and night sweats. Because her anti-dsDNA and ESR were elevated and hematuria was present, she was treated with prednisone for a presumed lupus flare, but her symptoms worsened rather than improved. Her presentation was also atypical for prior flares, which had mainly involved malar rash and poor appetite.<br /><br />On exam, she had arthralgia without clear arthritis and small hemorrhagic skin lesions on the feet, ankles, and thumb. Workup showed leukocytosis with neutrophilia and elevated CRP, findings less consistent with her usual SLE flares. Blood cultures were negative, echocardiogram showed no vegetations, and urine gonorrhea NAAT was negative. However, throat NAAT was positive for gonorrhea, revealing disseminated gonococcal infection (DGI) as the cause of her symptoms. A more detailed sexual history later revealed oral sex exposure despite her initial report of no recent sexual activity.<br /><br />The patient was treated with ceftriaxone for seven days and improved rapidly. Repeat gonococcal testing later became negative, and her partner sought treatment independently.<br /><br />The case emphasizes that DGI can mimic autoimmune flares, especially in immunosuppressed patients such as those with SLE. Classic DGI features include arthritis-dermatitis syndrome, purulent arthritis, and skin lesions that may be pustular, hemorrhagic, or papular, often on distal extremities. Because cultures from disseminated sites are frequently negative, diagnosis often depends on clinical suspicion and NAAT from appropriate sites, including pharyngeal testing when indicated. The report highlights the importance of maintaining a broad differential diagnosis, recognizing atypical infection in SLE, and taking a thorough sexual history.

Asset Subtitle

Joseph A. Cornett

Meta Tag

Author List Eveline Wu, Jessica L. Guidici, Joseph A. Cornett, Laura A. Cannon

Category Clinical Vignettes

Concept Disseminated Gonococcal Infection

Concept Arthritis-Dermatitis Syndrome

Concept NAAT

Concept Skin Lesion

Concept Sexual History

Distinguished Finalist

Presenter Organization University of North Carolina, Department of Internal Medicine and Department of Pediatrics

Presenting Author Joseph A. Cornett

Track Pediatric

Keywords

systemic lupus erythematosus

lupus nephritis

disseminated gonococcal infection

migratory polyarthralgia

fever

hemorrhagic skin lesions

pharyngeal gonorrhea

ceftriaxone treatment

autoimmune flare mimic

sexual history

Disseminated Gonococcal Infection

Arthritis-Dermatitis Syndrome

NAAT

Skin Lesion

Sexual History