Abstract
Disseminated gonococcal infection (DGI) is an uncommon manifestation of Neisseria gonorrhoeae infection and may rarely involve the endocardium. We report the case of a 48-year-old man who presented with progressive right wrist pain and swelling, back pain, intermittent fever, weight loss, and diarrhea. MRI demonstrated inflammatory changes involving the L3-L4 facet joints and sacroiliac joints. Culture from wrist aspiration grew N. gonorrhoeae, whereas blood cultures remained negative. Additional infectious evaluation showed a negative HIV screen, nonreactive syphilis testing, a negative hepatitis panel, and a negative urine nucleic acid amplification test/PCR for both Chlamydia trachomatis and N. gonorrhoeae. Transthoracic and transesophageal echocardiography demonstrated tricuspid vegetation and indeterminate bicuspid aortic valve involvement, while CT angiography confirmed tricuspid vegetations and showed an irregular ascending aortic plaque/atheroma without definite aortic valve vegetation. The patient underwent operative irrigation and debridement of the wrist and completed a six-week IV antibiotic course after multidisciplinary evaluation. This case highlights that DGI may present without classic mucocutaneous findings or positive mucosal testing and that negative blood cultures do not exclude disseminated disease or endocardial involvement.