Infect Chemother.  2015 Mar;47(1):60-63. 10.3947/ic.2015.47.1.60.

Disseminated Gonococcal Infection Presenting as Bacteremia and Liver Abscesses in a Healthy Adult

• Lee MH
• Byun J
• Jung M
• Yang JJ
• Park KH
• Moon SY
• Lee HJ
• Lee MS

• KMID: 1909525
• DOI: http://doi.org/10.3947/ic.2015.47.1.60

Abstract

Herein, we describe a bacteremia caused by Neisseria gonorrhoeae that presented as liver abscesses. The patient had no risk factors for disseminated gonococcal infection. Periodic fever, skin rashes, and papules were present and the results of an abdominal computed tomography scan indicated the presence of small liver abscesses. The results of blood culture and 16S rRNA sequencing of the bacterial isolates confirmed the presence of N. gonorrhoeae. The patient improved with antibiotic therapy.

Keyword

Neisseria gonorrhoeae; Liver abscesses; Disseminated gonococcal infection

MeSH Terms

Adult*
Bacteremia*
Exanthema
Fever
Humans
Liver Abscess*
Neisseria gonorrhoeae
Risk Factors

Figure

• 

  Figure 1 Skin examination results. (A) Many hemorrhagic rashes were noted on the foot. (B) Partly necrotic erythematous papule on the finger (black arrow).

• 

  Figure 2 Results of the abdominal computed tomography scan performed on admission indicated a small low-attenuated lesion with enhancing wall (white arrow) in the liver, suggesting a liver abscess. The size of the liver abscess was approximately 8 mm.

Reference

1. Bolan GA, Sparling PF, Wasserheit JN. The emerging threat of untreatable gonococcal infection. N Engl J Med. 2012; 366:485–487.

2. Korean Centers for Disease Control & Prevention. Surveillance system and current status of sexually transmitted infections in Korea. Public Health Wkly Rep. 2008; 1:429–433.

3. Suzaki A, Hayashi K, Kosuge K, Soma M, Hayakawa S. Disseminated gonococcal infection in Japan: a case report and literature review. Intern Med. 2011; 50:2039–2043.

4. Al-Suleiman SA, Grimes EM, Jonas HS. Disseminated gonococcal infections. Obstet Gynecol. 1983; 61:48–51.

5. Belding ME, Carbone J. Gonococcemia associated with adult respiratory distress syndrome. Rev Infect Dis. 1991; 13:1105–1107.

6. Eisenstein BI, Masi AT. Disseminated gonococcal infection (DGI) and gonococcal arthritis (GCA): I. Bacteriology, epidemiology, host factors, pathogen factors, and pathology. Semin Arthritis Rheum. 1981; 10:155–172.

7. Kerle KK, Mascola JR, Miller TA. Disseminated gonococcal infection. Am Fam Physician. 1992; 45:209–214.

8. Owino NO, Goldmeier D, Wall RA. Gonococcal septicaemia presenting as a subcutaneous abscess. Br J Vener Dis. 1981; 57:143–144.

9. Jain S, Win HN, Chalam V, Yee L. Disseminated gonococcal infection presenting as vasculitis: a case report. J Clin Pathol. 2007; 60:90–91.

10. Morse SA, Holmes KK. Gonococcal infections. In : Hoeprich PD, Jordan MC, Ronald AR, editors. Infectious diseases. 5th ed. New York: Harper and Row;1994. p. 670–685.

11. Kim GC, Lee CH, Lee JS, Chung MH, Choi JH, Moon YS. A case of concomitant disseminated gonococcal infection with acute viral hepatitis C. Infect Chemother. 2004; 36:175–180.

12. Kim JW, Song R, Im CH, Kim JH, Lee EY, Lee EB, Song YW. Disseminated gonococcal infection presenting as sweet syndrome. Korean J Med. 2011; 80:486–489.

13. Won D, An D, Kim MN, Lee YS. A case of bacteremia by Neisseria gonorrhoeae coincident with massive hemorrhage of esophageal varices. Korean J Lab Med. 2011; 31:118–121.

14. Dal Conte I, Starnino S, Di Perri G, Stefanelli P. Disseminated gonococcal infection in an immunocompetent patient caused by an imported Neisseria gonorrhoeae multidrug-resistant strain. J Clin Microbiol. 2006; 44:3833–3834.

15. Bardin T. Gonococcal arthritis. Best Pract Res Clin Rheumatol. 2003; 17:201–208.

16. Cannon JG, Buchanan TM, Sparling PF. Confirmation of association of protein I serotype of Neisseria gonorrhoeae with ability to cause disseminated infection. Infect Immun. 1983; 40:816–819.

17. Kim HJ, Seo Y, Kim WH, Lee Y, Lee H, Lee K, Chong Y. Antimicrobial resistance and molecular epidemiologic characteristics of Neisseria gonorrhoeae isolated from Korea in 2013. Ann Clin Microbiol. 2013; 16:182–187.

18. Ghosn SH, Kibbi AG. Cutaneous gonococcal infections. Clin Dermatol. 2004; 22:476–480.

19. Brown TJ, Yen-Moore A, Tyring SK. An overview of sexually transmitted diseases. Part I. J Am Acad Dermatol. 1999; 41:511–532.

20. Chung HC, Teng LJ, Hsueh PR. Liver abscess due to Neisseria sicca after repeated transcatheter arterial embolization. J Med Microbiol. 2007; 56:1561–1562.