Disseminated Gonococcal Infection
A 20-year-old woman presented to the emergency department with a rash involving the arms, legs, trunk, and scalp, which had erupted that morning. She also reported generalized muscle aches, fever, and pain in both ankles. Two weeks earlier, the patient had had vaginal intercourse with a new partner without barrier protection. The physical examination was notable for erythematous pustules near the wrist and on the fingers (Panel A) and on the trunk, scalp, and both ankles. There was mild swelling and pain with passive motion in the right ankle and tenosynovitis involving the tendons of both ankles. Given a high suspicion for disseminated gonococcal infection, treatment with ceftriaxone and azithromycin was initiated. Blood cultures grew gram-negative diplococci (Panel B) that were identified as Neisseria gonorrhoeae, which confirmed the diagnosis. The patient’s symptoms abated with antibiotic treatment. At 3 months of follow-up, the patient was feeling well, with no recurrence of skin lesions or joint pain.