S4914 The Enteric Fallout of a Systemic STI: New-Onset Inflammatory Bowel Disease After Disseminated Gonococcal Infection

Introduction: Disseminated Gonococcal Infection (DGI) is an uncommon complication of Neisseria gonorrhoeae, seen in 0.5%–3% of cases. It typically affects women under 40 and presents with arthritis-dermatitis syndrome. Gastrointestinal manifestations are exceedingly rare, and no prior reports describe DGI associated with new-onset inflammatory bowel disease (IBD). Case Description/Methods: A 25-year-old HIV-negative man with no autoimmune history presented with joint pain, body aches, and chest pain 1 week after hospitalization for DGI complicated by sepsis. Two months earlier, he was treated for urethral gonorrhea with IM ceftriaxone and oral cefixime. Persistent polyarthralgia led to NSAID initiation, while steroids were avoided due to infection risk. During admission, he developed watery diarrhea, hematochezia, abdominal pain, microcytic anemia, and a 10-lb weight loss. Stool studies for infection were negative. Labs showed erythrocyte sedimentation rate 129, C-reactive protein 121, calprotectin >3000, and positive lactoferrin. Computed tomography angiography abdomen/pelvis revealed nodular thickening and skip lesions in the colon and ileum. On readmission, colonoscopy revealed friable, nodular, erythematous mucosa in the cecum, hepatic flexure, and descending colon. Biopsies showed severe chronic active colitis with focal neutrophilic cryptitis, crypt microabscesses, ulceration, and granulation tissue. No dysplasia or granulomas were found. Epstein-Barr virus, LMP, and cytomegalovirus stains were negative. Discussion: To our knowledge, this is the first reported case of new-onset IBD in the context of DGI. While causality cannot be confirmed, N. gonorrhoeae may have triggered immune dysregulation and gut dysbiosis, unmasking Crohn’s disease. Management included antibiotic completion and referral for chronic IBD therapy. This case underscores the need to consider immune-mediated disease in patients with persistent gastrointestinal symptoms after systemic infection.