Abstract
Signs and symptoms of gonococcal infection in patients with systemic lupus erythematous (SLE) are overlapping and sometimes difficult to distinguish from the manifestations of SLE itself. We are reporting on a patient with a recent SLE flare who developed disseminated gonococcal infection (DGI) as a result of the nature of SLE and the management of a flare.
Highlights
Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disease characterized by multisystem inflammation and the presence of circulating autoantibodies directed against self-antigens according to Nelson Textbook of Pediatrics (841)
A 17-year-old African-American female with Systemic Lupus Erythematosus (SLE) that was treated for a polyarthritis due to Lupus flare
C-reactive protein (CRP) is a poor marker for a SLE flare, and any elevated CRP warrants a search for coincident inflammation or infection [4]
Summary
SLE is a chronic autoimmune disease characterized by multisystem inflammation and the presence of circulating autoantibodies directed against self-antigens according to Nelson Textbook of Pediatrics (841). Two weeks later the patient presented to the emergency room with complaints of pain and swelling originating in her right ankle that recently progressed bilaterally to her knees, ankles, wrists and fingers. She noted this pain as “more painful than usual,” claiming it was unresponsive to her usual treatment of NSAIDs and opiates. The patient’s right knee was aspirated, and the culture showed moderate growth of Neisseria gonorrhoeae Based on these findings she was diagnosed with DGI and treated with ceftriaxone (1 g intravenous) as well as her usual SLE flare treatment of intravenous Methylprednisolone, oral hydroxychloroquine, cyclobenzaprine and meloxicam. There was no evidence of arthritis, morning stiffness, muscle pain, fevers, or rash at follow-up three weeks later
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