Gonococcal Infective Endocarditis Returns

Abstract

Disseminated gonococcal infection occurs in 0.5%-3% of gonorrhea cases, usually in the form of either a triad of arthralgia, tenosynovitis, and skin lesions or purulent arthritis. Other rare complications include gonococcal infective endocarditis that occurs in 1%-2% of cases with 99 cases reported in the literature since 1938. Our case presents an additional rare case of aortic valve gonococcal endocarditis requiring surgical intervention and a prolonged antibiotic course, despite the absence of genitourinary symptoms or mucosal evidence of infection. This case was found to have sepsis and gonococcal endocarditis, which was clearly confirmed with positive blood cultures and aortic valve vegetation. It was further complicated by the evidence of splenic embolization and severe aortic regurgitation requiring surgical valve replacement and debridement of an annular perivalvular abscess. A high degree of suspicion is needed to early diagnose these unusual cases of gonococcal endocarditis, especially in sexually active individuals, for its known virulence causing valve destruction and high mortality. Our case represents a valuable addition to the reported cases of this diagnosis and is complemented by a short literature review.

Keywords: disseminated gonococcal infection; gonococci; infective endocarditis; septic emboli; sexually transmitted disease.

Figure 1. Abdominal CT showing a new 4.3-cm splenic infarct compared to the initial chest CT lower films of the previous day