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Case report
Septic arthritis in a previously healthy man with pan-negative infectious and rheumatologic work-up
  1. Ann Andee Wang1 and
  2. Elyse Anna Linson2
  1. 1 Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
  2. 2 Internal Medicine, Northwestern Memorial Hospital, Chicago, Illinois, USA
  1. Correspondence to Ann Andee Wang; annwang789{at}gmail.com

Abstract

Neisseria gonorrhoeae is the causative organism in 0.6%–1.2% of septic arthritis cases in North America and Europe, and classically presents as migratory polyarthralgias and tenosynovitis, with later development of septic oligoarthritis. In men, urine gonorrhoea nucleic amplification testing (NAAT) is the preferred diagnostic test, as its sensitivity surpasses that of joint and blood culture in disseminated infections. We present a case of a previously healthy man who presented with septic arthritis of the wrist. He denied any sexual activity in the previous year. Urine gonorrhoea NAAT and cultures were negative. However, N. gonorrhoeae was later identified via 16s PCR of the patient’s synovial fluid, leading to a delayed diagnosis of gonococcal arthritis. In patients with septic arthritis, gonococcal infection should remain on the differential despite reported sexual history and negative urine NAAT. Clinicians should continue to follow cultures and provide antibiotic coverage until a causative organism is identified.

  • infections
  • infectious diseases
  • bone and joint infections
  • sexual transmitted infections (bacterial)
  • gonorrhoea
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Footnotes

  • Contributors Both authors, EAL and AAW, contributed to the literature review, writing and revision process of this case report.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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