Which physical findings are characteristic of disseminated gonococcal infection (DGI)?

Updated: Sep 07, 2018
  • Author: Brian Wong, MD; Chief Editor: Pranatharthi Haran Chandrasekar, MBBS, MD  more...
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Answer

DGI may present with any of the following findings:

  • Fever - Usually a temperature of less than 39°C

  • Skin - Maculopapular, pustular, necrotic, or vesicular rash, typically occurring on the torso, limbs, palms, and soles may be present; the rash usually spares the face, scalp, and mouth; hemorrhagic lesions, erythema nodosum, urticaria, and erythema multiforme occur less frequently; the skin lesions are usually in different stages of development at the time of clinical presentation (see the image below)

    Disseminated gonococcemia, acral pustules. Disseminated gonococcemia, acral pustules.
  • Joints - Most patients may have polyarthralgia with joint tenderness, decreased range of motion, and erythema; less often, purulent arthritis may affect a single joint with severe pain, tenderness, edema, erythema, and decreased range of motion

  • Tenosynovitis - Presents as erythema and local tenderness along a tendon sheath, with pain on active or passive range of motion; tenosynovitis most often occurs in the hands but may be found in the tendons of the lower extremities as well

  • Central nervous system - Patients with gonococcal meningitis may present with meningismus or decreased mental status

  • Cardiac - Patients with gonococcal endocarditis may have a new murmur, tachycardia, and fever; embolic lesions may be present.; the aortic valve tends to be the main valve affected

  • Muscle - DGI can cause abscess formation within the soft tissues, presenting as localized tenderness, edema, and pain with motion

Certain patient populations, such as patients infected with HIV, can experience involvement of unusual joints, such as the sternoclavicular joint and the hips, and the arthritis may have a more aggressive course, with potential destruction of the joint.


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