Gonococcal Tenosynovitis Diagnosed with the Aid of Emergency Department Bedside Ultrasound
| Autor: | Jennifer Larson, Daniel Dexeus, Colleen E. Urban, Edward Carlin, Angela Cirilli, Mark Richman, Jessica Sidle |
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| Rok vydání: | 2018 |
| Předmět: |
Adult
Male medicine.medical_specialty Point-of-Care Systems medicine.medical_treatment Gonorrhea Arthritis 03 medical and health sciences 0302 clinical medicine New England Humans Medicine Ultrasonography 030203 arthritis & rheumatology Tenosynovitis business.industry Soft Tissue Infections Arthrocentesis 030208 emergency & critical care medicine Emergency department Joint effusion medicine.disease Dermatology Neisseria gonorrhoeae Anti-Bacterial Agents Tendon sheath Emergency Medicine Septic arthritis medicine.symptom Emergency Service Hospital business |
| Zdroj: | The Journal of Emergency Medicine. 54:844-848 |
| ISSN: | 0736-4679 |
| Popis: | Background Gonorrhea is the second most common sexually transmitted infection. Disseminated gonococcal infection (DGI) consists of gonococcal infection plus one or more of the triad of arthritis, tenosynovitis, and dermatitis. Diagnosis in the emergency department (ED) must be suspected clinically, as confirmatory tests are often not available. Point-of-care ultrasound (POCUS) can aid in diagnosis and appropriate management by identifying tenosynovitis and excluding arthritis. Case Report A 26-year-old man with multiple recent sex partners presented to the ED with slowly progressing right wrist pain and swelling over 5 days. His dorsal right wrist was swollen, with slightly decreased range of motion owing to mild pain, and no warmth, tenderness, erythema, or drainage. Multiple hemorrhagic, gray-purple blisters were noted over both hands. Serum white blood cell count was 12 × 103/μL; C-reactive protein was 30.3 mg/L. POCUS of the dorsal right wrist found no joint effusion; the extensor tendon sheath contained a large anechoic space with clear separation of the extensor tendons, suggesting a tendon sheath effusion/tenosynovitis. DGI was suspected, without septic arthritis. The patient was admitted and treated with ceftriaxone and azithromycin. Gonococcus grew from blood cultures and pharyngeal swabs. Why Should an Emergency Physician Be Aware of This? DGI must be suspected clinically, as confirmatory tests are often not available in the ED. Not all patients present with arthritis, tenosynovitis, and dermatitis. It is often difficult to differentiate tenosynovitis from arthritis. POCUS can aid in diagnosis by identifying tenosynovitis (vs. arthritis or simple soft-tissue swelling), allowing timely appropriate DGI diagnosis and management, and, importantly, averting unnecessary arthrocentesis. |
| Databáze: | OpenAIRE |
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