Diagnostic Considerations

In the pediatric population, the diagnosis of gonococcal arthritis must be considered if the patient is sexually active or abused. In the geriatric population, gonococcal arthritis is uncommon but should be considered if suggested by the patient’s sexual history.

In addition to the conditions listed in the differential diagnosis, other problems to be considered include the following:

Nongonococcal septic arthritis
Bacterial endocarditis
Parvovirus infection
Gout (may mimic septic arthritis and rarely occurs with gonococcal arthritis)

Infectious causes of fever and purpuric skin lesions include the following:

Rickettsial infections
Rocky Mountain spotted fever
Staphylococcal bacteremia
Enterovirus infection
Coxsackievirus infection
Echovirus infection

Noninfectious causes of fever and purpuric skin lesions include the following:

Systemic lupus erythematosus with small-vessel vasculitis
Rheumatoid arthritis with small-vessel vasculitis
Polyarteritis nodosa
Hypersensitivity vasculitis
Henoch-Schönlein purpura

Differential Diagnoses

Workup

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Media Gallery

Synovial joint.
The lesion on this patient's heel was due to the systemic dissemination of the N gonorrhoeae bacteria.
The foot of this patient is swollen due to gonococcal arthritis.
This patient presented with cutaneous foot lesions that were diagnosed as a disseminated gonococcal infection.

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Author

Victoria Fernandes Sullivan, MD Chief of Medicine, William Beaumont Army Medical Center

Victoria Fernandes Sullivan, MD is a member of the following medical societies: American College of Physicians, American College of Rheumatology

Disclosure: Nothing to disclose.

Coauthor(s)

Rachel Robbins, MD, FACP Assistant Professor of Medicine, Uniformed Services University of the Health Sciences; Staff Rheumatologist, Walter Reed National Military Medical Center

Rachel Robbins, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American College of Rheumatology, Association of Program Directors in Internal Medicine

Disclosure: Nothing to disclose.

Michael P Keith, MD, FACP, FACR Chief of Rheumatology, Walter Reed National Military Medical Center; Associate Professor of Medicine, Uniformed Services University of the Health Sciences, F Edward Hebert School of Medicine

Michael P Keith, MD, FACP, FACR is a member of the following medical societies: American College of Physicians, American College of Rheumatology, Clinical Immunology Society

Disclosure: Nothing to disclose.

Chief Editor

Herbert S Diamond, MD Visiting Professor of Medicine, Division of Rheumatology, State University of New York Downstate Medical Center; Chairman Emeritus, Department of Internal Medicine, Western Pennsylvania Hospital

Herbert S Diamond, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American College of Rheumatology, American Medical Association, Phi Beta Kappa

Disclosure: Nothing to disclose.

Acknowledgements

Lawrence H Brent, MD Associate Professor of Medicine, Jefferson Medical College of Thomas Jefferson University; Chair, Program Director, Department of Medicine, Division of Rheumatology, Albert Einstein Medical Center

Lawrence H Brent, MD is a member of the following medical societies: American Association for the Advancement of Science, American Association of Immunologists, American College of Physicians, and American College of Rheumatology

Disclosure: Genentech Honoraria Speaking and teaching; Genentech Grant/research funds Other; Amgen Honoraria Speaking and teaching; Pfizer Honoraria Speaking and teaching; Abbott Immunology Honoraria Speaking and teaching; Takeda Honoraria Speaking and teaching; UCB Speaking and teaching; Omnicare Consulting fee Consulting; Centocor Consulting fee Consulting

Timothy M Straight, MD Instructor, Department of Medicine, Uniformed Services University School of Medicine

Timothy M Straight, MD is a member of the following medical societies: American College of Physicians

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Gonococcal Arthritis Differential Diagnoses

Diagnostic Considerations

Differential Diagnoses

References

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