Case Series of Three Patients with Disseminated Gonococcal Infection and Endocarditis

Abstract

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.

Disseminated Gonococcal Infections—Lessons Learned From an Ongoing California Public Health Investigation

“…As we continue to surveil for DGI in CA, the burden of DGI nationwide comes into focus, with case clusters and series recently reported in Michigan 17 and South Carolina. 18 Disseminated *Local health departments interested in developing and standing up similar surveillance systems for DGI can contact the CDPH STD Control Branch at stdcb@cdph.ca.gov for further details regarding our CA DGI surveillance processes. † Confirmed DGI cases are those in which gonorrhea is isolated from a disseminated site (such as blood, synovial fluid, or cerebrospinal fluid).…”

“…As we continue to surveil for DGI in CA, the burden of DGI nationwide comes into focus, with case clusters and series recently reported in Michigan 17 and South Carolina 18 . Disseminated gonococcal infection cases may soon be on the rise elsewhere, or may already be occurring under the surveillance radar 19 .…”

Gonococcal endocarditis in a 32-year-old male: a rare presentation of an underrecognized disease – case report

“…DGI may present with atypical symptoms, such as tenosynovitis, polyarthralgia, and rash, in the absence of genitourinary symptoms. However, in 1% of cases, it can cause infective endocarditis (IE) involving heart valves, which can have severe and potentially fatal consequences 2 .…”