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Title: Een 55-jarige man met pijn en zwelling van pols en duim en verspringende artralgie
Author(s): KUBASIEWICZ L, CEYSSENS C, VERHAEGEN J, SCHRIJVERS R, PEETERMANS WE
Journal: Tijdschrift voor Geneeskunde
Volume: 63    Issue: 2-3   Date: 2007   
Pages: 89-91
DOI: 10.2143/TVG.63.02/03.2000020

Abstract :
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A case of disseminated gonococcal infection
We describe a 55-year-old male patient with disseminated gonococcal infection, acquired by unprotected sexual contact during his holiday in Thailand 4 weeks prior to admission.
He developed skin lesions of the right foot, tenosynovitis of the right wrist and purulent arthritis of the interphalangeal joint of the left thumb.
Initial treatment with ciprofloxacin did not lead to an improvement of the symptoms.
Diagnosis was made by culture of the synovial fluid which was inoculated bedside on chocolate agar. Neisseria gonorrhoeae, resistant to fluoroquinolones, was identified.
The patient was treated with ceftriaxone with quick resolution of the symptoms.
This case illustrates the importance of a direct inoculation of samples, when a gonococcal infection is suspected. Furthermore physicians have to consider ciprofloxacin-resistant N. gonorrhoeae. Current recommendations for treatment of N. gonorrhoeae single out third generation cephalosporins.

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