Gonococcal meningitis: An unusual presentation of disseminated gonococcal infection

Abstract

Gonorrhea is a sexually transmitted infection caused by Neisseria gonorrhoeae. The rate of N. gonorrhoeae infections in Canada has increased from 2010 to 2015. Disseminated gonococcal infection typically results from bacteremic spread of N. gonorrhoeae from a preceding mucosal site of disease (e.g., urogenital). Common clinical manifestations of disseminated gonococcal infection include skin lesions, tenosynovitis, and septic arthritis. Bacterial meningitis as a manifestation of disseminated gonococcal infection has been rarely described. A case of bacterial meningitis due to N. gonorrheae, complicated by an ischemic stroke, is reported here. Clinical features that may point to N. gonorrhoeae as the pathogen in a patient with bacterial meningitis include a concomitant active urogenital infection, skin rash, arthritis, and/or tenosynovitis. Parenteral ceftriaxone for 10 to 14 days combined with a single oral dose of azithromycin is currently recommended as the treatment for gonococcal meningitis in recent guidelines. This case is presented to highlight a potential, albeit rare, complication of a preventable disease that has resurged in the last decade in our community.

Difficult diagnosis: Disseminated gonorrheal infection manifesting as septic arthritis

“…Treatment protocols for DGI, following Centers for Disease Control and Prevention guidelines, advocate for the administration of a third-generation cephalosporin, specifically ceftriaxone, at a dosage of 1–2 g intravenously every 12–24 hr for a total duration of 10–14 days, supplemented with a single 1-g oral dose of azithromycin (Agabawi et al, 2019). Other third-generation cephalosporin options include cefotaxime and ceftizoxime.…”