Case Report

Severe Disseminated Gonococcal Infection with Polyarticular Gout: Two Cases in Older Travelers

Emma L. Smith, Kay E. Hodgetts, Anna P. Ralph, Nicholas M. Anstey

    Research output: Contribution to journalArticleResearchpeer-review

    Abstract

    Two male travelers with histories of gout and hazardous alcohol consumption, presented with a triad of severe culture-positive disseminated gonococcal infection, crystal-positive polyarticular gout, and gonococcal soft tissue collections, following unprotected sexual contact in The Philippines. Both men initially attributed symptoms to gout, since their usual joints were affected, but clinical deterioration occurred with self-administration of anti-inflammatory agents alone. The clinical courses were severe and protracted, requiring aggressive management of infection with prolonged intravenous antimicrobials and repeated surgery, and prolonged anti-inflammatory agents for gout. Joint symptom onset in each case occurred within a week of sexual exposure in conjunction with hazardous alcohol ingestion. We speculate that acute dissemination of infection to previously damaged joints triggered polyarticular gout, with progressive infection, exacerbated by unopposed anti-inflammatory agents and delayed antibiotics. Disseminated gonococcal infection can occur with polyarticular gout and delays in recognition and treatment, including while traveling, can lead to severe disease from both.

    Original languageEnglish
    Pages (from-to)209-212
    Number of pages4
    JournalThe American Journal of Tropical Medicine and Hygiene
    Volume100
    Issue number1
    DOIs
    Publication statusPublished - 1 Jan 2019

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    Gout
    Infection
    Anti-Inflammatory Agents
    Joints
    Philippines
    Self Administration
    Alcohol Drinking
    Eating
    Alcohols
    Anti-Bacterial Agents

    Cite this

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    title = "Case Report: Severe Disseminated Gonococcal Infection with Polyarticular Gout: Two Cases in Older Travelers",
    abstract = "Two male travelers with histories of gout and hazardous alcohol consumption, presented with a triad of severe culture-positive disseminated gonococcal infection, crystal-positive polyarticular gout, and gonococcal soft tissue collections, following unprotected sexual contact in The Philippines. Both men initially attributed symptoms to gout, since their usual joints were affected, but clinical deterioration occurred with self-administration of anti-inflammatory agents alone. The clinical courses were severe and protracted, requiring aggressive management of infection with prolonged intravenous antimicrobials and repeated surgery, and prolonged anti-inflammatory agents for gout. Joint symptom onset in each case occurred within a week of sexual exposure in conjunction with hazardous alcohol ingestion. We speculate that acute dissemination of infection to previously damaged joints triggered polyarticular gout, with progressive infection, exacerbated by unopposed anti-inflammatory agents and delayed antibiotics. Disseminated gonococcal infection can occur with polyarticular gout and delays in recognition and treatment, including while traveling, can lead to severe disease from both.",
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    Case Report : Severe Disseminated Gonococcal Infection with Polyarticular Gout: Two Cases in Older Travelers. / Smith, Emma L.; Hodgetts, Kay E.; Ralph, Anna P.; Anstey, Nicholas M.

    In: The American Journal of Tropical Medicine and Hygiene , Vol. 100, No. 1, 01.01.2019, p. 209-212.

    Research output: Contribution to journalArticleResearchpeer-review

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