[Clinical Picture] A disseminated gonococcal infection with spinal locations

A 43-year-old man was consulted for acute, inflammatory, cervical and low-back pain, associated with a swollen left elbow, wrist, and knee. He had a 38·5°C fever and elevated C-reactive protein concentration (265 mg/L). Knee aspiration showed an inflammatory synovial fluid (73 000 white blood cells per mm3; 80% neutrophils) without bacteria or microcrystals on direct examination. A disseminated infection of both the axial and peripheral joints was suspected and an empirical antibiotic therapy targeting Staphylococcus aureus was initiated, including cefazolin and gentamicin.