A 16-year-old girl with recent disseminated gonococcemia now presenting with a facial rash

Abstract

History of Present Illness A 16-year-old, girl was in her usual state of health until 2 months before her current admission, when she was admitted with disseminated gonococcemia for which she was treated with appropriate antibiotics. She was readmitted with a 3-day history of a red, nonpruritic facial rash and painful joints and fingers. The rash had started on her nose and progressed to involve her cheeks and both her ear canals. Although she had a 3-month history of a persistent and untreated scaly scalp rash and hair loss, her condition had worsened during the past 3 days. One day before admission, her left ankle and both her knees began to hurt, but this had not interfered with her physical activities. Several fingers on both her hands also became increasingly swollen and painful during the past day, both over the joints and in the soft tissue. Although she had some decrease in energy, she had not noticed any fevers or weight loss. She reported no change in vision, ear pain, discharge from ear, hearing loss, rhinorrhea or nasal congestion, or sore throat. She described swollen gums and a painful oral ulcer that occurred during the past 3 days. There was no shortness of breath, cough, chest pain, or palpitations, and she did not report abdominal pain, nausea, vomiting, diarrhea, or constipation. She had not had dysuria, increased urinary frequency, or blood in her urine but described a nonpruritic, white vaginal discharge that had been present since her first hospital admission. Her last menstrual period began approximately 2 days before presentation.