SHM Converge Scientific Abstract ePoster Gallery-Disseminated Gonococcal Infection Masked as a Rheumatic Fever Flare

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This case report highlights how disseminated gonococcal infection (DGI) can closely mimic other diseases, especially acute rheumatic fever. DGI is a complication of Neisseria gonorrhoeae infection that occurs in about 1–2% of cases and may present with migratory polyarthralgia, tenosynovitis, dermatitis, fever, purulent arthritis, and sometimes genitourinary symptoms. Because these features overlap with many infectious and inflammatory conditions, diagnosis often requires careful history, physical examination, and appropriate lab testing.<br /><br />The report describes a 24-year-old man with sickle cell trait, bicytopenia, and a prior diagnosis of acute rheumatic fever who presented with three weeks of fever, night sweats, migratory joint pain, and painful nodules on the lower extremities. He met Jones criteria for rheumatic fever, so his illness was initially interpreted as a rheumatic fever flare. However, blood cultures later grew N. gonorrhoeae, and after further discussion he disclosed an unprotected sexual encounter about one month before symptom onset. His clinical improvement on ceftriaxone and the culture results led to the conclusion that his symptoms were due to DGI.<br /><br />The authors emphasize that DGI is often misdiagnosed as septic arthritis, sexually transmitted infections, infective endocarditis, viral illnesses, or acute rheumatic fever. Blood cultures may be negative in many cases, so a negative culture does not exclude the diagnosis. The key lesson is to maintain suspicion for DGI in patients with compatible symptoms, especially when there is relevant sexual history, since prompt recognition and treatment are essential.

Asset Subtitle

Joseph M. Moirano

Meta Tag

Author List Elena Georgescu, John Moon, Joseph M. Moirano, Michael Vaysblat, Sanjit Parhar

Category Clinical Vignettes

Concept Disseminated Gonococcal Infection

Concept Migratory Polyarthralgia

Concept Tenosynovitis

Concept Purulent Arthritis

Concept Dermatitis

Distinguished Non-Finalist

Presenter Organization Donald and Barbara Zucker School of Medicine at Hofstra/Northwell

Presenting Author Joseph M. Moirano

Track Adult

Keywords

disseminated gonococcal infection

Neisseria gonorrhoeae

acute rheumatic fever

migratory polyarthralgia

tenosynovitis

dermatitis

blood cultures

ceftriaxone

sexual history

case report

Disseminated Gonococcal Infection

Migratory Polyarthralgia

Tenosynovitis

Purulent Arthritis

Dermatitis