SHM Converge Scientific Abstract ePoster Gallery-Beware the Flare: Gonococcal Septic Arthritis Mimicking Lupus Flare

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This case describes a 42-year-old woman with systemic lupus erythematosus (SLE) who presented with two days of severe polyarthritis involving the left wrist, right knee, and lower back. Her exam showed swollen joints with limited range of motion and bilateral knee effusions, but no warmth or erythema. Initial labs were strongly inflammatory, with markedly elevated CRP and ESR, low complement levels, and a normal white blood cell count with bandemia. Rheumatology initially treated her for a presumed lupus flare with high-dose IV steroids and maintenance medications.<br /><br />However, by hospital day 3 she had minimal improvement and persistently high inflammatory markers, prompting further evaluation. A right knee aspiration revealed 167,750 WBCs with 92% neutrophils, and washout produced grossly purulent fluid. Synovial fluid culture grew Neisseria gonorrhoeae, consistent with a positive urine NAAT. She was then treated with stress-dose steroids and a two-week course of ceftriaxone, after which her CRP declined and symptoms improved significantly.<br /><br />The case highlights that disseminated gonococcal infection (DGI) can mimic an SLE flare, especially in patients presenting with polyarthritis and effusions. DGI occurs in about 3% of gonococcal infections and can present as arthritis-dermatitis syndrome, septic arthritis, endocarditis, or meningitis. Risk factors include younger age, female sex, pregnancy, SLE, low complement levels, impaired reticuloendothelial function, and immunosuppressive therapy.<br /><br />Key teaching points are to keep DGI high on the differential in SLE patients with joint complaints, maintain a low threshold for joint aspiration and fluid analysis, and consider urine or cervical gonococcal NAAT early. Rapid recovery with appropriate antibiotics and partner treatment are important for management.

Asset Subtitle

Anna Symmes

Meta Tag

Author List Anna Symmes, Monica H. Xing

Category Clinical Vignettes

Concept Systemic Lupus Erythematosus

Concept Disseminated Gonococcal Infection

Concept Septic Arthritis

Concept Lupus Flare

Concept Joint Aspiration

Distinguished Non-Finalist

Presenter Organization The University of Chicago, Department of Medicine, Section of Hospital Medicine

Presenting Author Anna Symmes

Track Adult

Keywords

systemic lupus erythematosus

disseminated gonococcal infection

polyarthritis

septic arthritis

joint aspiration

Neisseria gonorrhoeae

ceftriaxone

inflammatory markers

low complement

synovial fluid culture

Systemic Lupus Erythematosus

Disseminated Gonococcal Infection

Septic Arthritis

Lupus Flare

Joint Aspiration