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

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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.

LanguageEnglish
Pages209-212
Number of pages4
JournalThe American Journal of Tropical Medicine and Hygiene
Volume100
Issue number1
DOIs
StatePublished - 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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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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