MOFFITT AM REPORT PEARLS 3/6/17: Disseminated Gonococcal Infection!

Hey Moffitt!

Thanks to Beth for presenting the case of a young man with acute oligoarticular arthritis with tenosynovitis, with a tap confirming gonococcal arthritis!

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See these prior pearls for info on gonococcal arthritis:

https://ucsfmed.wordpress.com/2016/09/02/moffitt-am-report-pearls-9216-gonococcal-arthritis/

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Additionally, here are some pearls that came up in today’s discussion:

*Pearl #1: Culture every site you can if you suspect DGI!

*Pearl #2: In one study, the mean incubation period of gonococcal infection was approximately 6 days.

*Pearl #3: Most patients with DGI did NOT have preceding symptomatic urogenital gonorrhea, but most DID have sexual contact within the past 30 days (but may not reveal that history)!

*Pearl #4: Treat with ceftriaxone AND azithromycin to cover chlamydia as well as resistant gonorrhea!

*Pearl #5: Couldn’t those gram negative diplococci on joint aspirate also be meningococcus? The answer is probably not, unless the patient also has severe signs of sepsis or meningitis. It would be rare for meningococcal infection to present as a primary purulent arthritis without these signs.

Here’s a figure cited in a 2005 review (below), showing the distribution of joint involvement between DGI and reactive arthritis. My take-home is that involvement of the larger upper extremity joints (shoulder, elbow, wrist), as in the case presented today, is suspicious for DGI.

gc

http://www.sciencedirect.com/science/article/pii/S0891552005000681

Have a great day everyone!

SamMy

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