Keimyung Med J.  2018 Dec;37(2):101-105. 10.0000/kmj.2018.37.2.101.

A Case of Monocular Gonococcal Conjunctivitis in an Adult Male

• Lee YH
• Ryoo NH
• Jun JH

• KMID: 2437311
• DOI: http://doi.org/10.0000/kmj.2018.37.2.101

Abstract

Gonococcal conjunctivitis is rare in adults and, if not treated properly, can cause corneal perforation. Gonococcal conjunctivitis typically presents with a severe mucopurulent discharge, similar to that associated with viral conjunctivitis. Here, we describe a case of monocular gonococcal conjunctivitis, including its clinical characteristics and slit-lamp images, which was initially misdiagnosed as epidemic conjunctivitis. A 20-year-old man was referred to our hospital with no improvement in monocular infection and purulent ocular discharge after 2-wk treatment using antibiotic and 0.1% fluorometholone eye drops at the local ophthalmic clinic. Initially, 0.5% loteprednol eye drops were used since we suspected viral conjunctivitis. Following this treatment, conjunctival infection worsened and a yellow-white ocular discharge covered the conjunctiva and cornea surface. Additional history taking revealed that the patient had sexual contact with a prostitute 1 wk prior to symptom presentation and, after the encounter, he took antibiotics for genital discharge at the local urology clinic, but self-discontinued treatment. A Gram staining showed gram-negative diplococci and culture of collected ocular discharge from the palpebral conjunctiva revealed growth of Neisseria gonorrhoeae, confirming gonococcal conjunctivitis. Following this, the patient was systemically treated with 3rd generation cephalosporin antibiotics. After 3-d treatment, conjunctival infection and purulent ocular discharge had significantly improved. When clinical symptoms are aggravated following steroid eye drop treatment for suspected monocular viral conjunctivitis, gonococcal conjunctivitis must be considered as a differential diagnosis

Keyword

Cephalosporin; Gonococcal conjunctivitis; Neisseria gonorrheae

MeSH Terms

Adult*
Anti-Bacterial Agents
Cephalosporins
Conjunctiva
Conjunctivitis*
Conjunctivitis, Viral
Cornea
Corneal Perforation
Diagnosis, Differential
Fluorometholone
Humans
Loteprednol Etabonate
Male*
Neisseria gonorrhoeae
Ophthalmic Solutions
Sex Workers
Urology
Young Adult
Anti-Bacterial Agents
Cephalosporins
Fluorometholone
Loteprednol Etabonate
Ophthalmic Solutions