Disseminated gonococcal infection in an elderly patient.
نویسندگان
چکیده
A protein profile disclosed no abnormalities except for mild hypoalbuminaemia (30 g/W). Antibodies against hepatitis B surface antigens and hepatitis B core antigens were positive. A test for hepatitis surface B antigen was negative. Complement C3 and C4 were normal. Immunoglobulin A was 5 g/l (normal <3-75). Tests for IgG and IgM, rheumatoid factor, antinuclear antibodies, the Veneral Disease Research Laboratory test, tests for thyroid hormones and somatotropin were all normal or negative, as were HLA-B27 and serological assays for Brucella, Salmonella, Yersinia enterocolitica, and Chiamydia spp. Roentgenograms of the chest showed imagesofconsolidation andmultiplecavitations in the superior lobe of the right lung, compatible with necrotising pneumonitis. Intradermoreaction with tuberculin 2U was positive. Microbiological examination of samples of sputum showed Gram positive cocci. Sputum and blood cultures were negative, and repeated searches found no mycobacteria in the sputum. Thereafter, percutaneous needle aspiration of the lung was performed. Cultures of the samples in anaerobic media were positive for microaerophilic Gram positive cocci and Bacteroides melaninogenicus. Cultures of stools were positive for Candida albicans. Upper gastrointestinal fibre endoscopyconfirmed thepresenceofintensecandida oesophagitis and hiatal hernia. Radiographs of the hands, feet, forearms, and legs showed typical signs of hypertrophic osteoarthropathy (figure). Synovial fluid from one knee was mildly inflammatory, it contained 3 5 x I09 cells/I, with more than 90% lymphocytes. The glucose concentration was 3-9 mmol/l, C3 was 500 mg/I, C4 80 mg/I. A search for microorganisms and crystals was negative. The patient was diagnosed as having AIDS, anaerobic necrotising pneumonitis, and secondary hypertrophic osteoarthropathy. He was treated with clindamycin, indomethacin, and zidovudine (AZT) and both his general condition and lung lesions improved rapidly. Five months later he was asymptomatic in his joints, and bone radiographic changes had almost disappeared.
منابع مشابه
Disseminated gonococcal infection in elderly patients.
Four elderly patients (71, 53, 57, and 62 years old) had disseminated gonococcal infection. Three patients presented with suppurative arthritis and the fourth with fever, skin lesions, and malaise. Although the signs and symptoms did not differ from those in the younger age group, the diagnosis was not considered clinically. All gonococci were susceptible to penicillin.
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ورودعنوان ژورنال:
- Annals of the rheumatic diseases
دوره 52 1 شماره
صفحات -
تاریخ انتشار 1993