A case of primary extragenital cutaneous gonorrhea affecting the left middle finger of a 16-year-old female patient is presented. The patient denied a history of sexual activity and the only reported symptoms were finger pain and associated lymphangitis. Wound culture was obtained from an incision, and drainage procedure was performed at an emergency room of a community hospital. Laboratory diagnosis was made at a clinical microbiology laboratory using Gram stain, agar culture, and matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). Concurrent blood cultures had no growth at 5 days. The patient was switched from Cephalexin and Trimethoprim-sulfamethoaxole to an appropriate regimen upon sensitivity testing. The patient was lost to follow-up, and it is unknown if the possibility of seeding mucosal infection, such as the pharynx, was investigated.

Some laws in the United States define cannabis-impaired driving criteria using various per se language that uses specific concentrations of various cannabinoid compounds to establish driving-under-the-influence (DUI). We hypothesize that there will be decedents whose postmortem toxicology profiles would be considered indicative of an acute cannabinoid intoxication under varying DUI per se laws, despite having survived longer than the expected duration of cannabinoid impairment effects. This study examined decedents in whom quantified cannabis metabolites were detected in Connecticut medical examiner autopsy samples, in which the medically-confined survival interval was longer (4-12 and > 12 h) than the expected duration of cannabinoid impairment effects. Several of the 15 decedents, despite being intubated and/or comatose during the medically-confined period of abstinence, would have exceeded DUI per se limits based upon their toxicology results. The use of drug concentrations alone to equate to an acute cannabis intoxication may result in inappropriate arrest, prosecution, and civil liability.