S3204 A Case of Acute Abdomen Due to Neisseria Gonorrhea

Abstract

Introduction: Neisseria gonorrhea is a globally prevalent sexually transmitted infection (STI). In 2018, the WHO estimated 583,405 cases in the United States representing a 63% increase since 2014. Generally, it presents as infections of the urogenital tract. Rarely, it can become disseminated causing extragenital manifestations. Here we highlight a case of disseminated gonococcal infection presenting as an acute abdomen due to purulent peritonitis. Case Description/Methods: A 23-year-old female with a history of intravenous drug use presented with sudden onset abdominal pain ongoing for one day with nausea and diarrhea. The pain was achy and worsened with respiration or movement. On exam, the abdomen was diffusely tender with rebound and guarding. Labs were significant for leukocytosis 13.5 thou/cmm with bandemia 35% and elevated CRP 407 mg/L. CT abdomen revealed mesenteric edema suggestive of enteritis. Follow up CT angiogram was negative for mesenteric ischemia or vasculitis. Patient was started on antibiotics and pain control. However, there was no significant improvement in her clinical symptoms prompting exploratory laparotomy, which revealed purulent peritonitis. Notably, the intraabdominal structures were normal appearing. Given history of unprotected sex with a new partner, there was concern for a urogenital source despite lack of classical symptoms. Pelvic exam was unrevealing without signs of cervicitis or discharge. However, cervical swab was positive for Gonorrhea. Blood cultures were negative. Patient underwent re-exploration of the peritoneal cavity, which again was negative for structural abnormalities. Ultimately, she was diagnosed with purulent peritonitis secondary to disseminated gonococcal infection. Symptoms improved after a 10-day course of ceftriaxone. Discussion: Purulent peritonitis is an extremely rare manifestation of Neisseria gonorrhea. The exact incidence is unknown, but only a handful of case reports document such presentation. It is thought to arise due to transfallopian seeding of the peritoneal cavity. Our case demonstrates the importance of considering STIs in cases of acute abdomen. Given that most gonococcal infections remain asymptomatic, routine screening should be offered to sexually active individuals at high risk of infection, including those with new sexual partners, multiple sexual partners, or a history of STIs. Furthermore, it is important to encourage evaluation and treatment of sexual partners to prevent further transmission.