![]() 2,3 Early in the disease course, blood cultures may be positive for gonococci, whereas cultures of skin lesions with chocolate agar and modified Thayer-Martin media are often negative. Generally, the diagnosis is made clinically however, it is advisable to confirm the presence of the organism by culture isolation. 5 The WBC count is usually mini-mally elevated, as in this patient. These lesions are thought to be microabscesses of the skin that are secondary to embolization of bacteria. Erythematous pinpoint macules may progress to vesiculopustules, tender or necrotic papules, or hemorrhagic bullae. Typically, few (between 2 and 20) lesions erupt, mostly on the distal extremities. 1Ībout 50% of patients with disseminated infection have dermatitis. HIV-infected patients often have involvement of typically unaffected joints, such as the sternoclavicular and hip joints. 2 Disseminated gonococcemia most commonly features a pauciarticular arthritis of the wrists, fingers, elbows, knees, and ankles. The gonococcal arthritis-dermatitis syndrome typically presents as a 3-week primary infection with joint pain, fever, and rash. 3 Interestingly, the gonococci that cause disseminated infection are distinct from those that cause urethritis in that the former are resistant to complement- mediated bactericidal activity. The pathogenesis of the gonococcal arthritis-dermatitis syndrome is unclear however, bacteremia and immune complex formation have been demonstrated. Untreated, asymptomatic primary disease is more common in women who are predisposed to gonococcal dissemination by menstruation and pregnancy. ![]() Intravenous ceftriaxone, 1 g qd, and oral doxycycline, 100 mg q12h, were given symptoms resolved within 48 hours.ĭisseminated gonorrhea occurs in 0.5% to 3% of patients with gonorrhea. Subsequently, blood and cervical cultures grew Neisseria gonorrhoeae on Thayer-Martin and chocolate agar media ( C). The white blood cell (WBC) count was 10,560/µL.Ī clinical diagnosis of disseminated gonococcemia, or gonococcal arthritis-dermatitis syndrome, was made. Joint tenderness was present in the left foot and knee and the right ankle. Newly erupted lesions were seen on the soles the patient had applied skin cream to an early pustule on the left sole. Three weeks after the original diagnosis, the patient was admitted to the hospital with night sweats, fever, and a rash.Ībout 20 nontender pustules were noted on the patient's hands, wrists, buttocks, and feet ( A and B). One week later, joint pain and skin lesions developed. Metronidazole was given for 8 days, and the symptoms resolved. A 17-year-old girl, who reported having unprotected sexual intercourse, complained of lower abdominal pain vaginal trichomoniasis was diagnosed.
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