SHM Converge Scientific Abstract ePoster Gallery-Oh, It's Gonorrhea! Disseminated Gonococcal Infection Presenting With Petechial Rash

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This case report describes an unusual presentation of disseminated gonococcal infection (DGI) in a 46-year-old woman. She presented with 4 days of fever, acute migratory polyarthritis, and a generalized petechial rash affecting the neck, trunk, extremities, palms, and soles, while sparing the face and oral mucosa. She also denied typical risk factors or symptoms of sexually transmitted infection.<br /><br />Initial evaluation showed leukocytosis with markedly elevated inflammatory markers (ESR and CRP), along with low complement C3 and C4 levels. Extensive testing for other causes of vasculitic or infectious rash was negative, including ANA, ANCA, viral hepatitis, HIV, Rocky Mountain spotted fever, Anaplasma, syphilis, and Coxsackie B. Skin biopsy demonstrated leukocytoclastic vasculitis with fibrinoid necrosis, RBC extravasation, and a neutrophil-rich perivascular infiltrate, without IgA deposition.<br /><br />The diagnosis was confirmed when blood cultures grew Neisseria gonorrhoeae and urine NAAT was positive for gonorrhea. She was treated with intravenous ceftriaxone, after which both the rash and arthritis improved during hospitalization.<br /><br />The authors emphasize that although DGI classically presents with tenosynovitis, polyarthralgia, and a vesiculopustular rash, it can also manifest with petechial or purpuric lesions. Cutaneous findings may mimic vasculitis or other dermatologic disorders. They also note that hypocomplementemia may predispose otherwise healthy patients to DGI. The report highlights the importance of considering DGI in patients with petechial or purpuric rash accompanied by migratory joint symptoms, even when sexual history is noncontributory.

Asset Subtitle

Asmi Chattaraj

Meta Tag

Author List Anjana Chandrasekhara Pillai, Asmi Chattaraj, Khubaib Ahmad, Tahreem Ahmad, Waqas Ali

Category Clinical Vignettes

Concept Disseminated Gonococcal Infection

Concept Petechial Rash

Concept Purpuric Rash

Concept Tenosynovitis

Concept Polyarthralgia

Distinguished Non-Finalist

Presenter Organization UPMC McKeesport

Presenting Author Asmi Chattaraj

Track Adult

Keywords

disseminated gonococcal infection

Neisseria gonorrhoeae

petechial rash

migratory polyarthritis

leukocytoclastic vasculitis

hypocomplementemia

ceftriaxone

blood cultures

urine NAAT

sexually transmitted infection

Disseminated Gonococcal Infection

Petechial Rash

Purpuric Rash

Tenosynovitis

Polyarthralgia