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

Emma L. SmithDivision of Medicine, Royal Darwin Hospital, Darwin, Australia;

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Kay E. HodgettsDivision of Medicine, Royal Darwin Hospital, Darwin, Australia;

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Anna P. RalphDivision of Medicine, Royal Darwin Hospital, Darwin, Australia;
Global and Tropical Health Division, Menzies School of Health Research, Darwin, Australia

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Nicholas M. AnsteyDivision of Medicine, Royal Darwin Hospital, Darwin, Australia;
Global and Tropical Health Division, Menzies School of Health Research, Darwin, Australia

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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.

Author Notes

Address correspondence to Emma L. Smith, Royal Darwin Hospital, 105 Rocklands Dr., Tiwi, Darwin 0810, Australia. E-mail: emma.smith0709@gmail.com

Authors’ addresses: Emma L. Smith and Kay E. Hodgetts, Division of Medicine, Royal Darwin Hospital, Darwin, Australia, E-mails: emma.smith0709@gmail.com and kay.hodgetts@nt.gov.au. Anna P. Ralph and Nicholas M. Anstey, Menzies School of Health Research, Darwin, Australia, E-mails: anna.ralph@menzies.edu.au and nicholas.anstey@menzies.edu.au.

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