SHM Converge Scientific Abstract ePoster Gallery-More Than Meets the Eye: Gonococcal Conjunctivitis in Children

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This case report describes a 10-year-old girl who presented with rapidly worsening unilateral eye pain, copious purulent discharge, foreign body sensation, painful eye movements, and headache. Exam showed marked eyelid edema, conjunctival injection, and heavy drainage. CT imaging demonstrated acute conjunctivitis, preseptal cellulitis, and a small conjunctival phlegmon. Because the swelling initially limited eye examination, corneal involvement could not be immediately excluded.<br /><br />An eye culture grew pan-sensitive Neisseria gonorrhoeae, confirming gonococcal conjunctivitis. She was treated with ceftriaxone, initially at a higher dose until corneal involvement was ruled out, then standard dosing for a total of 5 days. She also received doxycycline for presumed chlamydia coinfection, though PCR later ruled this out. Ophthalmology follow-up confirmed complete symptom resolution and preserved vision.<br /><br />Given the patient’s age, the team involved a child abuse specialist, the Family Advocacy Center, and the Department of Children and Families to evaluate for possible sexual abuse. A full STI workup found gonorrhea in the throat but no other infections, and testing of household adults was negative. After a 2-month investigation, no clear evidence of abuse was identified.<br /><br />The authors note that gonorrhea is uncommon but important in younger children, and rapidly progressive purulent conjunctivitis should prompt consideration of gonococcal infection. Routine conjunctivitis cultures are usually low yield, but in highly purulent cases, Gram stain, culture, or PCR can quickly identify Neisseria and guide treatment. This matters because delayed treatment can lead to corneal scarring, blindness, or disseminated infection such as meningitis, septic arthritis, or septicemia. The case emphasizes early empiric ceftriaxone when suspicion is high and highlights the need to consider both medical and safeguarding implications in preadolescent patients.

Asset Subtitle

Jessica Malhotra-Nogueras

Meta Tag

Author List David Fish, Jessica Malhotra-Nogueras

Category Clinical Vignettes

Concept Gonococcal Conjunctivitis

Concept Conjunctivitis

Concept Purulent Discharge

Concept Ceftriaxone

Concept Sexual Abuse

Distinguished Non-Finalist

Presenter Organization Baystate UMass Chan Combined Internal Medicine - Pediatrics Department

Presenting Author Jessica Malhotra-Nogueras

Track Pediatric

Keywords

gonococcal conjunctivitis

Neisseria gonorrhoeae

purulent conjunctivitis

preseptal cellulitis

child abuse evaluation

ceftriaxone treatment

ophthalmology follow-up

corneal involvement

sexually transmitted infection

pediatric case report

Gonococcal Conjunctivitis

Conjunctivitis

Purulent Discharge

Ceftriaxone

Sexual Abuse