Fulminant Disseminated Gonococcal Infection Complicated by Meningitis, Endocarditis, and Septic Shock in an Immunocompetent Young Woman: A Case Report

Disseminated gonococcal infection (DGI) is an uncommon but potentially life-threatening complication of Neisseria gonorrhoeae infection caused by hematogenous dissemination from mucosal sites. The classical manifestations of DGI include dermatitis, tenosynovitis, and migratory polyarthritis. Severe invasive complications such as meningitis, endocarditis, septic shock, and multiorgan failure are rare.An 18-year-old immunocompetent woman with no significant past medical history presented to the infectious diseases ward with fever and severe suprapubic pain. On admission, her temperature was 38.2°C, blood pressure was 130/85 mmHg, heart rate was 80 beats/min, respiratory rate was 18 breaths/min, and oxygen saturation was 98% on room air. Physical examination revealed multiple painful pustular and hemorrhagic bullous lesions measuring approximately 1 mm over the elbows, along with clinical evidence of tenosynovitis.Microbiological investigations confirmed disseminated gonococcal infection, with N. gonorrhoeae isolated from vaginal swab, blood, and synovial fluid cultures. Concurrent Chlamydia trachomatis infection was identified. Treatment was initiated with intravenous ceftriaxone (1 g once daily) and oral doxycycline (100 mg twice daily). Despite antimicrobial therapy, the patient developed polyarthritis on hospital day 5, mitral valve endocarditis on day 7, severe hepatic dysfunction on day 8, and acute kidney injury and meningitis on day 9. Cerebrospinal fluid culture subsequently confirmed N. gonorrhoeae. On day 10, she developed septic shock requiring intensive care admission and norepinephrine support. Seizures developed on day 11, and the patient died on day 12 from septic shock secondary to disseminated gonococcal infection with multiorgan failure.This case illustrates a rare, fulminant presentation of DGI with progressive involvement of the skin, musculoskeletal system, cardiovascular system, central nervous system, and multiple organs. Early recognition of characteristic DGI manifestations, prompt microbiological investigation, and timely initiation of appropriate antimicrobial therapy are essential components of management.