Gonococcal Septic Arthritis of the Wrist in an Elderly Patient: A Case Report

Gonococcal arthritis classically affects young, sexually active adults, and this profile shapes clinical suspicion.We report a 75-year-old man with hypertension and dyslipidaemia who presented with acute purulent monoarthritis of the right wrist.Synovial fluid was purulent (170,501 leukocytes/µL, 89.7% polymorphonuclear cells, crystals negative); the Gram stain showed Gram-negative diplococci, and culture of the joint fluid grew Neisseria gonorrhoeae, as did other samples taken at surgery.The isolate was reported as "sensitive" (drugs tested and minimum inhibitory concentration (MIC) values not available); no blood culture results are available.No skin lesions or tenosynovitis were documented, and a urine multiplex polymerase chain reaction (PCR) collected on day 7, after antibiotics had started, was negative, so dissemination was not established.He underwent arthrotomy and lavage on day 1 and received ceftriaxone 2 g daily until day 14, a single dose of azithromycin 500 mg, and, guided by susceptibility, oral ciprofloxacin for seven days.At three months, he was asymptomatic (Visual Analogue Scale (VAS) 0/10 and Disabilities of the Arm, Shoulder and Hand (DASH) 25/100).At one year, he had no complaints, full mobility, and no recurrence.Imaging showed advanced carpal osteoarthritis, so structural changes could not be attributed to infection.This case suggests that gonococcal septic arthritis should be considered in older patients with acute purulent monoarthritis; as a single case, it does not establish a treatment approach.