Dacryoadenitis due to gonococcal conjunctivitis complicated by corneal perforation.

Adnexal and periocular involvement in Neisseria gonorrhoeae (NG) infection is rare. This report describes the case of a patient with a delayed diagnosis of gonococcal dacryoadenitis with contiguous conjunctivitis and corneal involvement. She underwent extensive inpatient laboratory and infectious workup but rapidly progressed to corneal perforation requiring emergent penetrating keratoplasty prior to a positive culture confirming the diagnosis. To date, this is the first reported case of ophthalmologic NG infection with associated conjunctivitis, dacryoadenitis, and corneal perforation.

Gonococcal endocarditis: a case report and review of the literature.

A 59-year-old Caucasian male presented with progressive dyspnea, arthralgias and fever for three days. A diastolic regurgitation murmur was detected in the aortic area. A transesophageal echocardiograph showed several vegetations and severe aortic regurgitation. Blood cultures yielded Neisseria gonorrhoeae beta-lactamase negative. The patient had not noticed any urogenital discomfort or urethral discharge. The patient successfully underwent surgery for septal abscess debridement. The patient received ceftriaxone 2 g bid for eight weeks and the clinical follow-up was uneventful. The review of the literature revealed a total of the 38 additional cases reported between 1980 and the present. The majority of the patients were young, male and with native valve involvement. There has been a clear tendency for left-sided valve involvement (especially in the aortic valve). All valve cultures were reported negative despite, in most cases, the marked tissue destruction. Polymerase chain reaction was performed in two patients and positive results were shown in both. Cultures of exudates from other locations were negative in most cases. One striking fact is the high proportion of patients who underwent surgery (72 %). Information regarding antibiotic sensitivity was available in 28 cases, with penicillin resistance reported in six patients (21 %) and intermediate sensitivity in four patients (14 %). Resistance to ciprofloxacin was reported in two cases (7 %). A rapid increase and distribution of isolates resistant to third generation cephalosporins have been recently detected. The mortality is high, particularly taking into account that most were young patients who had not presented previous heart disease.

Corneal perforation requiring corneal grafting: a rare complication of gonococcal eye infection.

The authors present a case of severe gonococcal conjunctivitis associated with corneal perforation of the right eye in a 25-year-old homosexual man. Inpatient management and corneal grafting were required. The authors demonstrate that Neisseria gonorrhoea should be considered in the presence of purulent conjunctival discharge with a white patch on the cornea or reduced vision. Regardless of whether a patient has genital symptoms, they should be referred urgently to an ophthalmologist to ensure adequate treatment of this rare but sight-threatening complication.

Neisseria gonorrhoeae endocarditis confirmed by nucleic acid amplification assays performed on aortic valve tissue.

The Aptima Combo 2 assay is proposed as a rapid method of diagnosing Neisseria gonorrhoeae endocarditis or other suspected disseminated gonococcal disease.

[Perianal abscess after anal intercourse should raise suspicion of rectal gonorrhoeae infection].

Neisseria gonorrhoeae infection is a sexually transmitted disease. Rectal gonorrhoea is often asymptomatic, the most common symptoms are anal pain, bleeding and purulent discharge. This case report describes a younger man, who experienced increasing anal pain and later fever after anal intercourse. N. gonorrhoeae infection was verified, before a clinical examination revealed a perianal abscess. During incision of the abscess an anal fistula was suspected, and six weeks after primary surgery and treatment with relevant antibiotics, transanal ultrasonography showed perianal scarring and no signs of anocutaneous fistula.

High-Frequency Ultrasound Imaging-Guided Wedge Resection: An Effective Treatment for Paraurethral Duct Dilatation Following Gonococcal Paraurethral Duct Infection in Men.

This study was performed to evaluate the therapeutic effects of wedge resection on male paraurethral duct dilatation following gonococcal paraurethral duct infection. Twenty-six men with paraurethral duct dilatation following gonococcal paraurethral duct infection were enrolled. Their lesions underwent wedge resection after examination using an ACUSON X300 ultrasound system. The anesthetic method, surgical duration, intraoperative blood loss, wound healing time, complications, sequelae, and curative effect were assessed. All 26 men received local infiltration anesthesia. The mean surgical duration was 18.65 ± 2.50 min (range, 14-23 min), the mean intraoperative blood loss was 10.50 ± 1.68 ml (range, 8-14 ml), and the mean wound healing time was 14.73 ± 1.31 days (range, 13-17 days). The lesions were cured in all patients (100%). The postoperative wounds healed in all patients. No complications or glans defects were observed in any patients. The study identifies that high-frequency ultrasound imaging-guided wedge resection is an effective and safe therapy for paraurethral duct dilatation following gonococcal paraurethral duct infection in men.

Phenotypic Investigation of Regenerated Epithelial Cells After Gonococcal Corneal Perforation: A Clinical, Histological, and Immunohistochemical Study.

PURPOSE: To determine the characteristics of regenerated epithelial cells after severe gonococcal infection after corneal perforation. METHODS: Pathological tissue was obtained from the cornea at the time of surgery. Hematoxylin and eosin staining and immunohistochemical analysis were performed for cytoskeletal keratins (K12, K13, and K15), basement membrane and junctional markers (laminin 5, ZO-1 and Desmoplakin), and proliferative and mesenchymal markers (Ki67, α-SMA, and vimentin). RESULTS: A 42-year-old patient with severe gonococcal keratoconjunctivitis rapidly progressed to corneal perforation during administration of intensive topical and systemic antibiotics. After conservative treatment, the perforation healed and 5- × 3-mm corneal ectasia occurred with localized iris attachment. Complete closure of the cornea was confirmed by a negative Seidel test. After lamellar keratoplasty to improve corneal integrity and to prevent secondary glaucoma, the pathological tissue revealed a poorly organized epithelial layer at the regenerated ectatic area. The regenerated epithelial cells clearly expressed K12, ZO-1, and Desmoplakin with underlying laminin 5 (+) basement membrane. K15 and Ki67 expressions were observed predominantly at the limbal area but not in the regenerated area. α-SMA and vimentin were sporadically expressed in the underlying connective tissue. CONCLUSIONS: We speculate that the process of epithelial wound healing at the site of corneal perforation was responsible for migration of the surrounding epithelial cells. Although the regenerated cells expressed several cytokeratins and junctional markers, they remained disorganized and fragile.

Gonococcal endocarditis during pregnancy: simultaneous cesarean section and aortic valve surgery.

Gonococcal endocarditis is a rare and potentially fatal consequence of disseminated gonococcal infection. Presented is the first known case of culture-proved gonococcal and serratia endocarditis in pregnancy. The case was further complicated by fetal distress at 30 weeks' gestation as a result of maternal decompensation from worsening congestive heart failure secondary to rapid destruction of her aortic valve. Consequently, cardiopulmonary bypass with subsequent aortic valve replacement and implantation of a left ventriculoaortic shunt was initiated immediately after an emergency cesarean section.

Neisseria gonorrhoeae mycotic ascending aortic aneurysm.

Mycotic aneurysms of the ascending aorta are rare. We report the case of a 38-year-old woman with systemic lupus erythematosus being treated with steroids who presented with a large Neisseria gonorrhoeae ascending aortic aneurysm. She was successfully treated with surgical resection of the aneurysm and prolonged postoperative antibiotic therapy.

Deep anterior lamellar keratoplasty in a patient with descemetocele following gonococcal keratitis.

PURPOSE: To describe the presentation and subsequent management of a case of severe gonococcal keratitis in a young man. DESIGN: Case report. METHODS: A young man presented with severe gonococcal keratitis. Topical and systemic antibiotics were given with no improvement, and progressive corneal melting was noted. Deep lamellar keratoplasty was performed. The clarity and state of corneal graft and the postoperative visual acuity were noted. RESULTS: At 6 months posttreatment, the graft was clear, and no recurrence of infection was noticed. Corrected visual acuity was 20/25. CONCLUSION: Deep lamellar keratoplasty should be considered as a therapeutic option in patients with severe gonococcal keratitis that does not respond to antibiotic treatment.

The functional treatment of pyogenic arthritis of the adult knee.

A method of treatment of pyogenic arthritis of the adult knee employing wide open arthrotomy and early active motion, as well as synovectomy in some knees, was used in thirty-four patients with pyogenic arthritis of the knee. Of these patients, sixteen had a good result, twelve had a fair result, and six had a poor result. This method of treatment was used as a salvage procedure in most of the patients, but may have more general application in the treatment of pyogenic arthritis of the knee.

Neisseria gonorrhoeae paravertebral abscess.

The authors present the case of an isolated gonococcal paravertebral abscess with an epidural component in a 42-year-old man. A primary epidural abscess of the spine is a rare condition and is most commonly caused by Staphylococcus aureus. In this report, the authors present their therapeutic decisions and review the relevant literature on disseminated gonococcal infection in a patient presenting with an epidural abscess. A 42-year-old Indonesian man was admitted with symptoms of neck and upper back pain and bilateral lower-limb weakness. Clinical examination was unremarkable apart from tenderness over the lower cervical spine. Postgadolinium T1-weighted MRI of the cervical and thoracic spine demonstrated an enhancing lesion in the right paraspinal and epidural soft tissue at C-6 to T1-2, in keeping with a spinal epidural abscess. The patient underwent laminectomy of C-7 and T-1 with abscess drainage. Tissue cultures subsequently grew Neisseria gonorrhoeae that was resistant to quinolones by genotyping. Upon further questioning, the patient admitted to unprotected sexual intercourse with commercial sex workers. Further investigations showed that he was negative for other sexually transmitted infections. Postoperatively, he received a course of beta-lactam antibiotics with good recovery. Clinicians should be aware of this unusual disseminated gonococcal infection manifested in any patient with the relevant risk factors.

Sequential therapy for gonococci inflammation of paraurethral glands in males.

OBJECTIVE: To approach the method of sequential therapy in gonococcal inflammation of the paraurethral glands around the external urethral orifice in males. METHODS: Step one: ceftriaxone sodium (1 g intramuscularly (IM) once daily for 5 days) was used for all patients. Step two: refractory patients from step one were treated with incision and drainage, followed by administration of IM ceftriaxone sodium. Step three: patients' sinus tracts were cauterized with a monopulse CO(2) laser. RESULTS: After step one, 34 patients recovered (recovery rate 70.83%). However, 14 patients were unaffected, and sinus tracts appeared in two patients. After step two, 11 of 14 patients recovered and three patients developed sinus tracts, two of whom had sinus tracts in step one that did not heal in step two. After step three, all patients with sinus tracts that had been treated with monopulse CO(2) laser therapy recovered in 2 weeks. CONCLUSION: This sequential therapy can be used to successfully treat gonococcal inflammation of the paraurethral glands around the external urethral orifice in males.

Isolated gonococcal ascending aorta aneurysm.

We present a very rare case of an acute septic infection and vegetative mycotic aneurysm caused by Neisseria gonorrhoeae in a 52-year old male. The aortic valve was bicuspid and calcified. He was successfully treated by the resection of the ascending aorta and the aortic valve with a replacement by separate prostheses, followed by 2 weeks of intravenous antibiotic therapy. The patient was followed up 18 months postoperatively with no signs of reinfection.

Acute suppurative salpingitis with concomitant intrauterine pregnancy.

A 20-year-old woman presented to the emergency department with a history of lower abdominal pain and recent loss of consciousness. She was admitted with a primary diagnosis of abdominal pain; ectopic pregnancy was ruled out. The culture of the endocervix was positive for Neisseria gonorrhoeae. Surgical exploration of the pelvis was performed, and histological analysis of the specimen showed an acute suppurative salpingitis and an intrauterine pregnancy. The patient was placed on intravenous antibiotics. Postoperative course was unremarkable, and the patient was discharged on oral antibiotics. Although a rare entity acute suppurative salpingitis with concomitant intrauterine pregnancy are not mutually exclusive. Ectopic pregnancy should be the presumptive diagnosis when clinical presentation is consistent with pelvic inflammatory disease and pregnancy especially in the first trimester. Patients who are pregnant and exhibit clinical signs and symptoms that are consistent with salpingitis should be admitted for aggressive management of their high-risk pregnancy. Fetal wastage seems to be significant in spite of aggressive management. Endocervical culture for N gonorrhoeae should be obtained from all pregnant patients with follow-up treatment pending culture results. The following is a case presentation along with a review of the existing cases in the English literature and discussion of the possible pathogenesis and clinical outcome of this entity.