DGI

Q: 35 years old female with no past medical history is admitted to ICU with sepsis-like symptoms. On examination, the patient is found to have asymmetric pain and swelling on the knees, wrists, and ankle joints. Patient acknowledged having more than one sexual partner in the last few months and having unprotected sex. The patient was diagnosed with disseminated gonococcal infection (DGI) with septic arthritis. These subsets of patients tend to present with high fevers.

A) True

B) False

Answer: B

Patients with DGI present in two distinct categories for reasons not yet fully understood.

1. Arthritis-dermatitis syndrome, which has a classic triad of

• tenosynovitis
• dermatitis, and 
• polyarthralgia

2. Purulent arthritis

Later, as the disease advances, two forms may intermingle and further disseminate with endocarditis, myopericarditis, meningitis, osteomyelitis, abscesses, and vasculitis.

Fever, chills, and generalized malaise are common in arthritis-dermatitis syndrome. Also, it is interesting that as the disease advances, this fever tends to disappear relatively abruptly, leaving the notion that the patient might have flu-like symptoms. This delays seeking care significantly.

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References:

1. Bleich AT, Sheffield JS, Wendel GD Jr, et al. Disseminated gonococcal infection in women. Obstet Gynecol 2012; 119:597.

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

3. Gelfand SG, Masi AT, Garcia-Kutzbach A. Spectrum of gonococcal arthritis: evidence for sequential stages and clinical subgroups. J Rheumatol 1975; 2:83.

4. García-De La Torre I, Nava-Zavala A. Gonococcal and nongonococcal arthritis. Rheum Dis Clin North Am 2009; 35:63.