TY - JOUR
T1 - Case Report
T2 - Severe Disseminated Gonococcal Infection with Polyarticular Gout: Two Cases in Older Travelers
AU - Smith, Emma L.
AU - Hodgetts, Kay E.
AU - Ralph, Anna P.
AU - Anstey, Nicholas M.
PY - 2019/1/1
Y1 - 2019/1/1
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85059799025&partnerID=8YFLogxK
U2 - 10.4269/ajtmh.18-0589
DO - 10.4269/ajtmh.18-0589
M3 - Article
C2 - 30457099
AN - SCOPUS:85059799025
SN - 0002-9637
VL - 100
SP - 209
EP - 212
JO - The American Journal of Tropical Medicine and Hygiene
JF - The American Journal of Tropical Medicine and Hygiene
IS - 1
ER -