Disseminated gonorrhea presenting as cellulitis of the hand: A case report

A 35-year-old man presented with left-hand pain, swelling, and erythema. He was initially treated with prednisone, and his symptoms briefly improved but worsened shortly after. Lab tests showed elevated inflammatory markers, and he was referred to rheumatology for suspected rheumatoid arthritis. He later returned to the emergency department with worsening joint pain and painful urination. Imaging revealed muscle swelling without abscess, and he was treated with intravenous antibiotics for presumed cellulitis. Although symptoms improved, cultures later confirmed gonorrhea. He received ceftriaxone and azithromycin at urgent care; then completed intravenous treatment at the hospital. This case illustrates an unusual presentation of disseminated gonorrhea, which typically affects skin and joints, but can mimic cellulitis. Clinicians should consider gonorrhea in the differential diagnosis of unexplained joint pain and swelling, especially when accompanied by urinary symptoms or skin involvement, even in the absence of typical signs of a sexually transmitted infection.