Case Series of Three Patients with Disseminated Gonococcal Infection and Endocarditis

Introduction: The increasing incidence of Neisseria gonorrhoeae infections and emergence of cephalosporin-resistant strains means the threat of disseminated gonococcal infection and endocarditis needs to be reimagined into the differential diagnosis for patients treated in the emergency department (...

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Autores principales:	Phillip Moschella, Hannah Shull, Mark Pittman, Alex Gleason, Prerana Roth
Formato:	article
Lenguaje:	EN
Publicado:	eScholarship Publishing, University of California 2021
Materias:	Medical emergencies. Critical care. Intensive care. First aid RC86-88.9
Acceso en línea:	https://doaj.org/article/b1b7df31c38344d2995ce6ee1976b334
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spelling	oai:doaj.org-article:b1b7df31c38344d2995ce6ee1976b3342021-11-23T20:02:51ZCase Series of Three Patients with Disseminated Gonococcal Infection and Endocarditis2474-252X10.5811/cpcem.2021.7.53404https://doaj.org/article/b1b7df31c38344d2995ce6ee1976b3342021-11-01T00:00:00Zhttps://escholarship.org/uc/item/5df0k5b5https://doaj.org/toc/2474-252XIntroduction: The increasing incidence of Neisseria gonorrhoeae infections and emergence of cephalosporin-resistant strains means the threat of disseminated gonococcal infection and endocarditis needs to be reimagined into the differential diagnosis for patients treated in the emergency department (ED) for sexually transmitted infections and for endocarditis itself. Only 70 cases of disseminated gonococcal infection (DGI) with endocarditis had been reported through 2014. 1– 4 In 2019, however, an outbreak of DGI with one case of endocarditis was reported. 5 This case series of three patients with DGI and endocarditis, in addition to the recent outbreak, may represent a warning sign for reemergence of this threat. Case Report: We describe three cases within a recent three-year period of gonococcal endocarditis as seen and treated at our institution. These cases show divergent presentations of this insidious disease with both classical and atypical features. One case displayed a classic migratory rash with positive urine testing and a remote history of sexually transmitted infections, while another patient developed isolated culture-confirmed endocarditis with negative cervical testing and imaging, and the final case was a male patient who presented to the ED with fulminant endocarditis as the first ED presentation of infection. Conclusion: Secondary to an overall rise in incidence and possibly due to increasing antibiotic-resistance patterns, gonococcal endocarditis should be included in the differential diagnosis of any case of endocarditis. Reciprocally, increased vigilance should surround the evaluation of any patient for sexually transmitted diseases while in the ED for both the development of DGI and endocarditis.Phillip MoschellaHannah ShullMark PittmanAlex GleasonPrerana RotheScholarship Publishing, University of CaliforniaarticleMedical emergencies. Critical care. Intensive care. First aidRC86-88.9ENClinical Practice and Cases in Emergency Medicine, Vol 5, Iss 4 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medical emergencies. Critical care. Intensive care. First aid RC86-88.9
spellingShingle	Medical emergencies. Critical care. Intensive care. First aid RC86-88.9 Phillip Moschella Hannah Shull Mark Pittman Alex Gleason Prerana Roth Case Series of Three Patients with Disseminated Gonococcal Infection and Endocarditis
description	Introduction: The increasing incidence of Neisseria gonorrhoeae infections and emergence of cephalosporin-resistant strains means the threat of disseminated gonococcal infection and endocarditis needs to be reimagined into the differential diagnosis for patients treated in the emergency department (ED) for sexually transmitted infections and for endocarditis itself. Only 70 cases of disseminated gonococcal infection (DGI) with endocarditis had been reported through 2014. 1– 4 In 2019, however, an outbreak of DGI with one case of endocarditis was reported. 5 This case series of three patients with DGI and endocarditis, in addition to the recent outbreak, may represent a warning sign for reemergence of this threat. Case Report: We describe three cases within a recent three-year period of gonococcal endocarditis as seen and treated at our institution. These cases show divergent presentations of this insidious disease with both classical and atypical features. One case displayed a classic migratory rash with positive urine testing and a remote history of sexually transmitted infections, while another patient developed isolated culture-confirmed endocarditis with negative cervical testing and imaging, and the final case was a male patient who presented to the ED with fulminant endocarditis as the first ED presentation of infection. Conclusion: Secondary to an overall rise in incidence and possibly due to increasing antibiotic-resistance patterns, gonococcal endocarditis should be included in the differential diagnosis of any case of endocarditis. Reciprocally, increased vigilance should surround the evaluation of any patient for sexually transmitted diseases while in the ED for both the development of DGI and endocarditis.
format	article
author	Phillip Moschella Hannah Shull Mark Pittman Alex Gleason Prerana Roth
author_facet	Phillip Moschella Hannah Shull Mark Pittman Alex Gleason Prerana Roth
author_sort	Phillip Moschella
title	Case Series of Three Patients with Disseminated Gonococcal Infection and Endocarditis
title_short	Case Series of Three Patients with Disseminated Gonococcal Infection and Endocarditis
title_full	Case Series of Three Patients with Disseminated Gonococcal Infection and Endocarditis
title_fullStr	Case Series of Three Patients with Disseminated Gonococcal Infection and Endocarditis
title_full_unstemmed	Case Series of Three Patients with Disseminated Gonococcal Infection and Endocarditis
title_sort	case series of three patients with disseminated gonococcal infection and endocarditis
publisher	eScholarship Publishing, University of California
publishDate	2021
url	https://doaj.org/article/b1b7df31c38344d2995ce6ee1976b334
work_keys_str_mv	AT phillipmoschella caseseriesofthreepatientswithdisseminatedgonococcalinfectionandendocarditis AT hannahshull caseseriesofthreepatientswithdisseminatedgonococcalinfectionandendocarditis AT markpittman caseseriesofthreepatientswithdisseminatedgonococcalinfectionandendocarditis AT alexgleason caseseriesofthreepatientswithdisseminatedgonococcalinfectionandendocarditis AT preranaroth caseseriesofthreepatientswithdisseminatedgonococcalinfectionandendocarditis
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Case Series of Three Patients with Disseminated Gonococcal Infection and Endocarditis

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