A 75-year-old man who suffered severe right-hand wrist pain and swelling without any history of trauma was diagnosed with gonococcal septic arthritis, a rare joint infection caused by the bacterium responsible for gonorrhea, according to a case report published in the international journal Cureus.
Severe Wrist Pain Linked to Gonococcal Infection
A 75-year-old male patient arrived at an emergency room experiencing intense pain and severe swelling in his right wrist that had developed over approximately three days, kormedi.com reported. The patient reported a pain level of 8 out of 10, and the joint had become difficult to move. While he was taking medication for high blood pressure and dyslipidemia, he reported no history of insect bites or physical trauma to the wrist, and he ran no fever.
Physical examinations revealed tenderness in the right wrist both during active movement and when manipulated by medical staff. There were no open wounds on the skin. Initial blood tests showed a C-reactive protein (CRP) level of 335 mg/L, vastly exceeding the normal clinical threshold of under 5 mg/L.
Surgical Drainage and Antibiotic Treatment
Orthopedic and trauma surgeons at the Entre Douro e Vouga health district in Portugal extracted roughly 4mL of turbid, pale yellow pus from the wrist joint using a needle aspiration. Bacterial cultures of the fluid identified Neisseria gonorrhoeae, the pathogen that causes gonorrhea, while tests ruled out uric acid crystals associated with gout.
The patient underwent surgery on the day of his hospital admission to open the wrist joint, drain the hemorrhagic purulent fluid, and irrigate the internal structures. Subsequent tissue cultures confirmed the presence of the same bacteria. Following targeted antibiotic therapy, the patient’s condition improved steadily. A urine test on the seventh day of hospitalization detected no gonococcal bacteria, and a three-month follow-up confirmed that the wrist stiffness and pain had fully resolved.
Clinical Implications for Elderly Patients
Gonococcal arthritis typically affects sexually active young adults and more commonly targets the knees rather than the wrists. The presentation of a 75-year-old patient developing a single infected joint from the bacterium remains highly unusual. Researchers noted that the patient mentioned experiencing urethral discharge roughly a week prior to his hospital visit, a detail not captured during his initial intake.
Medical staff emphasized that the absence of concurrent urogenital symptoms does not rule out gonococcal arthritis, as joint pain can easily eclipse prior urinary signs. Septic arthritis is a medical emergency that requires prompt intervention to prevent irreversible joint damage. Clinicians advise that sudden, severe joint inflammation in older adults should be evaluated for bacterial infections even in the absence of fever, and patients should disclose any recent urogenital discharge to ensure accurate diagnosis.
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