Cutaneous manifestations of disseminated gonococcemia

Abstract

Background: Sexually transmitted infections, including urogenital gonorrheal infection, are a growing health concern in the United States. Nearly 50% of cervical infections are asymptomatic. If left undiagnosed and untreated, there is a risk of disseminated infection. Purpose: To describe an 18-year-old woman presenting with disseminated gonococcal infection confirmed by blood cultures, skin biopsy, and urine gonococcal probe. We also describe the presentation, diagnosis, and treatment of disseminated gonococcal infection, including discussion of the various morphologies of cutaneous lesions that have been reported in the literature. Materials and Methods: The features of a woman with disseminated gonococcal infection are presented. Using PubMed, the terms cutaneous, disseminated, gonococcal, gonorrhea, infection, lesions, manifestations, pustules, skin, and systemic were searched. Relevant citations were utilized and discussed. Results: Hemorrhagic pustules, petechiae, and purpuric lesions developed in a young woman with fever and joint pain. Blood cultures grew beta lactamase negative Neisseria gonorrhoeae and the Neisseria gonorrhoeae/Chlamydia trachomatis probe was positive for both N. gonorrhoeae and C. trachomatis. Biopsy revealed bulla with neutrophils, extravasated erythrocytes, fibrin deposits in the vessel walls, and leukocytoclasia. Conclusion: Cutaneous lesions of disseminated gonococcal infection can include abscesses, cellulitis, petechiae, purpuric macules, necrotizing fasciitis, and vasculitis. It is important for the clinician to recognize the clinical signs and symptoms of disseminated gonococcal infection, particularly the various cutaneous manifestations.