{"pk":1097,"title":"Case Series of Three Patients with Disseminated Gonococcal Infection and Endocarditis","subtitle":null,"abstract":"Introduction: \nThe increasing incidence of Neisseria gonorrhoeae infections and emergence of cephalosporin-resistant strains means the threat of disseminated gonococcal infection and endocarditis needs to be reimagined into the differential diagnosis for patients treated in the emergency department (ED) for sexually transmitted infections and for endocarditis itself. Only 70 cases of disseminated gonococcal infection (DGI) with endocarditis had been reported through 2014.1-4 In 2019, however, an outbreak of DGI with one case of endocarditis was reported.5 This case series of three patients with DGI and endocarditis, in addition to the recent outbreak, may represent a warning sign for reemergence of this threat.\nCase Report:\n We describe three cases within a recent three-year period of gonococcal endocarditis as seen and treated at our institution. These cases show divergent presentations of this insidious disease with both classical and atypical features. One case displayed a classic migratory rash with positive urine testing and a remote history of sexually transmitted infections, while another patient developed isolated culture-confirmed endocarditis with negative cervical testing and imaging, and the final case was a male patient who presented to the ED with fulminant endocarditis as the first ED presentation of infection.\nConclusion:\n Secondary to an overall rise in incidence and possibly due to increasing antibiotic- resistance patterns, gonococcal endocarditis should be included in the differential diagnosis of any case of endocarditis. Reciprocally, increased vigilance should surround the evaluation of any patient for sexually transmitted diseases while in the ED for both the development of DGI and endocarditis.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"Neisseria gonorrhoeae"},{"word":"gonococcal endocarditis"},{"word":"disseminated gonococcal infection"},{"word":"case report"},{"word":"case series"}],"section":"Case Series","is_remote":true,"remote_url":"https://escholarship.org/uc/item/5df0k5b5","frozenauthors":[{"first_name":"Phillip","middle_name":"","last_name":"Moschella","name_suffix":"","institution":"Prisma Health-Upstate, Department of Emergency Medicine, Greenville, South Carolina","department":"None"},{"first_name":"Hannah","middle_name":"","last_name":"Shull","name_suffix":"","institution":"Prisma Health-Upstate, Department of Emergency Medicine, Greenville, South Carolina","department":"None"},{"first_name":"Mark","middle_name":"","last_name":"Pittman","name_suffix":"","institution":"Prisma Health-Upstate, Department of Emergency Medicine, Greenville, South Carolina","department":"None"},{"first_name":"Alex","middle_name":"","last_name":"Gleason","name_suffix":"","institution":"Prisma Health-Upstate, Department of Emergency Medicine, Greenville, South Carolina","department":"None"},{"first_name":"Prerana","middle_name":"","last_name":"Roth","name_suffix":"","institution":"Prisma Health-Upstate, Department of Infectious Diseases, Greenville, South Carolina","department":"None"}],"date_submitted":"2021-10-26T18:31:33-04:00","date_accepted":"2021-10-26T18:31:33-04:00","date_published":"2021-10-26T18:33:00-04:00","render_galley":null,"galleys":[{"label":"","type":"","path":"https://journalpub.escholarship.org/uciem_cpcem/article/1097/galley/838/download/"}]}