Division of Medicine, Royal Darwin Hospital, Darwin, Australia.
Global and Tropical Health Division, Menzies School of Health Research, Darwin, Australia.
Am J Trop Med Hyg. 2019 Jan;100(1):209-212. doi: 10.4269/ajtmh.18-0589.
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.
两名男性旅行者均有痛风和危险饮酒史，在菲律宾进行无保护性行为后，出现了严重的淋球菌感染、晶体阳性多关节炎性痛风和淋球菌软组织感染三联征。由于他们通常的关节受到影响，两人最初都将症状归因于痛风，但在单独使用抗炎药后，病情恶化。临床病程严重且持久，需要积极管理感染，使用长时间的静脉内抗生素和反复手术，并长期使用抗炎药治疗痛风。在每种情况下，关节症状均在性接触后一周内出现，同时伴有危险饮酒。我们推测，感染急性播散到先前受损的关节引发了多关节炎性痛风，随着感染的进展，抗炎药的拮抗作用和抗生素的延迟使用加重了病情。淋球菌感染可并发多关节炎性痛风，而在旅行时，包括在旅行时，认识和治疗的延迟会导致这两种疾病的严重后果。
