DGI

Q; 35 years old male is admitted to ICU with sepsis and disseminated gonococcal infection (DGI) is suspected. Patient is found to have purulent polyarthritis. Polyarthritis in DGI is usually? (select one)

A) symmetric

B) asymmetric

Answer: B

Although with recent advances, DGI is not frequently encountered, few features of DGI are unique and may help to establish differential diagnoses. Some of the characteristics of DGI are:

• It is usually of abrupt onset
• monoarthritis is relatively more common
• if there is polyarthritis, it's usually asymmetric. 
• mostly afebrile
• urethritis is unlikely to precede DGI 

Although a "classic triad" of tenosynovitis, dermatitis, and polyarthralgia is described but is not always present. 

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References:

1. Birrell JM, Gunathilake M, Singleton S, Williams S, Krause V. Characteristics and Impact of Disseminated Gonococcal Infection in the "Top End" of Australia. Am J Trop Med Hyg. 2019 Oct;101(4):753-760. doi: 10.4269/ajtmh.19-0288. PMID: 31392956; PMCID: PMC6779203.

2. Bardin T. Gonococcal arthritis. Best Pract Res Clin Rheumatol 2003; 17:201.

3. Rice PA. Gonococcal arthritis (disseminated gonococcal infection). Infect Dis Clin North Am 2005; 19:853.