Wang Ann Andee, Linson Elyse Anna
Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
Internal Medicine, Northwestern Memorial Hospital, Chicago, Illinois, USA.
BMJ Case Rep. 2020 Feb 3;13(2):e231823. doi: 10.1136/bcr-2019-231823.
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, 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.
在北美和欧洲，该病原体在0.6%-1.2%的脓毒性关节炎病例中被发现，典型表现为游走性多关节痛和腱鞘炎，随后发展为脓毒性寡关节炎。对于男性，尿液淋病核酸扩增检测（NAAT）是首选的诊断测试，因为在播散性感染中其敏感性超过关节和血液培养。我们报告一例既往健康的男性，他出现了手腕部的脓毒性关节炎。他否认前一年有任何性活动。尿液淋病NAAT和培养均为阴性。然而，后来通过对患者滑液进行16s PCR鉴定出该病原体，导致淋菌性关节炎的诊断延迟。在患有脓毒性关节炎的患者中，尽管有性病史报告且尿液NAAT为阴性，淋菌感染仍应列入鉴别诊断。临床医生应继续追踪培养结果并提供抗生素覆盖，直至确定病原体。
