Acute hepatitis in a biological male patient secondary to suspected disseminated gonococcal infection in the absence of Fitz-Hugh-Curtis syndrome: a case report.

BACKGROUND: Disseminated gonococcal infection is well described in the literature and most commonly presents with signs and symptoms of systemic inflammation including arthritis, tenosynovitis, dermatitis, or imaging findings consistent with Fitz-Hugh-Curtis syndrome. This condition is characterized by inflammation of the liver capsule with adhesion formation-most commonly a sequela of chronic pelvic inflammatory disease. However, there are no documented cases of acute hepatitis secondary to disseminated gonococcal infection in the absence of these findings.

CASE PRESENTATION: Here we present a case report of a 31-year-old Caucasian biological male presenting with abdominal pain found to have acute hepatitis and Neisseria gonorrhoeae bacteremia. He reported no arthritic or dermatologic symptoms, and his imaging findings were not consistent with Fitz-Hugh-Curtis syndrome. His abdominal pain and hepatic injury greatly improved following treatment of his disseminated gonococcal infection with ceftriaxone and doxycycline. Given his remarkable improvement on antibiotic therapy and his otherwise unremarkable workup, his acute hepatitis was strongly suspected to be secondary to disseminated gonococcal infection.

CONCLUSION: To our knowledge, this is the first reported case of disseminated gonococcal infection causing acute hepatitis in the absence of the previously listed systemic findings or a diagnosis of Fitz-Hugh-Curtis syndrome. This case highlights the diagnostic challenges in disseminated gonococcal infection-related hepatitis and underscores the need to maintain a broad differential diagnosis when managing a patient with acute hepatitis of unknown origin.