[Infective endocarditis, a complication of Neisseria gonorrhoeae infection]

Gonococcal Infective Endocarditis Returns

Disseminated gonococcal infection occurs in 0.5%-3% of gonorrhea cases, usually in the form of either a triad of arthralgia, tenosynovitis, and skin lesions or purulent arthritis. Other rare complications include gonococcal infective endocarditis that occurs in 1%-2% of cases with 99 cases reported in the literature since 1938. Our case presents an additional rare case of aortic valve gonococcal endocarditis requiring surgical intervention and a prolonged antibiotic course, despite the absence of genitourinary symptoms or mucosal evidence of infection. This case was found to have sepsis and gonococcal endocarditis, which was clearly confirmed with positive blood cultures and aortic valve vegetation. It was further complicated by the evidence of splenic embolization and severe aortic regurgitation requiring surgical valve replacement and debridement of an annular perivalvular abscess. A high degree of suspicion is needed to early diagnose these unusual cases of gonococcal endocarditis, especially in sexually active individuals, for its known virulence causing valve destruction and high mortality. Our case represents a valuable addition to the reported cases of this diagnosis and is complemented by a short literature review.

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.