SHM Converge Scientific Abstract ePoster Gallery-An Unusual Case of Wrist Swelling

Pdf Summary

This case describes a 52-year-old woman with discoid lupus on mycophenolate and hydroxychloroquine, plus gout, who presented with acute right wrist swelling, pain, and low-grade fever. She had no trauma and no other joint involvement. Initial labs were largely unremarkable except for markedly elevated ESR and mildly elevated CRP; wrist x-ray was normal.<br /><br />The differential included septic arthritis, lupus flare, and gout. Joint aspiration showed inflammatory fluid, but no crystals. She was started empirically on broad-spectrum IV antibiotics and underwent incision and drainage by orthopedics. Synovial fluid culture later grew Neisseria gonorrhoeae, and urine NAAT was positive for gonorrhea, confirming disseminated gonococcal infection (DGI). Blood cultures were negative. She had no typical genital or urinary symptoms and denied rash, abdominal pain, dysuria, or vaginal discharge.<br /><br />DGI is a rare manifestation of gonorrhea that classically presents as a triad of arthritis, tenosynovitis, and skin lesions, or as abrupt purulent mono- or oligoarthritis, often affecting the wrist, knee, or ankle. Many patients are asymptomatic before onset. Cultures are positive only about half the time, so NAAT is more sensitive. Synovial fluid in septic arthritis often shows high white cell counts, though this case had a lower count than expected.<br /><br />Because lupus can predispose patients to DGI and lupus flares can mimic infection, clinicians should consider alternative causes of septic arthritis even without obvious risk factors. Management requires prompt source control and IV ceftriaxone, typically for 7–14 days, longer in immunocompromised patients or slow responders. Comprehensive STI screening is important because co-infection can occur. In this case, she completed 4 weeks of ceftriaxone and had complete symptom resolution.

Asset Subtitle

Faizaan Khan

Meta Tag

Author List Aisha Uraizee, Amer Mohiuddin, Faizaan Khan, Valerie Carter

Category Clinical Vignettes

Concept Disseminated Gonococcal Infection

Concept Septic Arthritis

Concept Classic Triad

Concept NAAT

Concept Synovial Fluid

Distinguished Non-Finalist

Presenter Organization Medical College of Wisconsin

Presenting Author Faizaan Khan

Track Adult

Keywords

disseminated gonococcal infection

gonorrhea

septic arthritis

wrist swelling

systemic lupus erythematosus

mycophenolate

hydroxychloroquine

synovial fluid culture

ceftriaxone

joint aspiration

Disseminated Gonococcal Infection

Septic Arthritis

Classic Triad

NAAT

Synovial Fluid