Statistics

 array:24 [
  "pii" => "S2173574319301145"
  "issn" => "21735743"
  "doi" => "10.1016/j.reumae.2017.08.012"
  "estado" => "S300"
  "fechaPublicacion" => "2019-11-01"
  "aid" => "1123"
  "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología"
  "copyrightAnyo" => "2017"
  "documento" => "simple-article"
  "crossmark" => 0
  "subdocumento" => "crp"
  "cita" => "Reumatol Clin. 2019;15:e125-e127"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:1 [
    "total" => 0
  ]
  "Traduccion" => array:1 [
    "es" => array:19 [
      "pii" => "S1699258X17302346"
      "issn" => "1699258X"
      "doi" => "10.1016/j.reuma.2017.08.010"
      "estado" => "S300"
      "fechaPublicacion" => "2019-11-01"
      "aid" => "1123"
      "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología"
      "documento" => "simple-article"
      "crossmark" => 1
      "subdocumento" => "crp"
      "cita" => "Reumatol Clin. 2019;15:e125-e127"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 2417
        "formatos" => array:3 [
          "EPUB" => 71
          "HTML" => 1837
          "PDF" => 509
        ]
      ]
      "es" => array:13 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Caso cl&#237;nico</span>"
        "titulo" => "Artritis gonoc&#243;cica y d&#233;ficit de C2"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "tieneResumen" => array:2 [
          0 => "es"
          1 => "en"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "e125"
            "paginaFinal" => "e127"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Gonococcal Arthritis and C2 Deficiency"
          ]
        ]
        "contieneResumen" => array:2 [
          "es" => true
          "en" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig0005"
            "etiqueta" => "Figura 1"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr1.jpeg"
                "Alto" => 819
                "Ancho" => 900
                "Tamanyo" => 91749
              ]
            ]
            "descripcion" => array:1 [
              "es" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Artritis de ambos carpos con tenosinovitis&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Diego Benavent N&#250;&#241;ez, Carolina Tornero Mar&#237;n, Gema Bonilla Hern&#225;n, Adela Garc&#237;a Perea, Alejandro Balsa Criado, Alicia Rico Nieto"
            "autores" => array:6 [
              0 => array:2 [
                "nombre" => "Diego"
                "apellidos" => "Benavent N&#250;&#241;ez"
              ]
              1 => array:2 [
                "nombre" => "Carolina"
                "apellidos" => "Tornero Mar&#237;n"
              ]
              2 => array:2 [
                "nombre" => "Gema"
                "apellidos" => "Bonilla Hern&#225;n"
              ]
              3 => array:2 [
                "nombre" => "Adela"
                "apellidos" => "Garc&#237;a Perea"
              ]
              4 => array:2 [
                "nombre" => "Alejandro"
                "apellidos" => "Balsa Criado"
              ]
              5 => array:2 [
                "nombre" => "Alicia"
                "apellidos" => "Rico Nieto"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S2173574319301145"
          "doi" => "10.1016/j.reumae.2017.08.012"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => false
            "ES2" => false
            "LATM" => false
          ]
          "gratuito" => false
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574319301145?idApp=UINPBA00004M"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X17302346?idApp=UINPBA00004M"
      "url" => "/1699258X/0000001500000006/v1_201911200727/S1699258X17302346/v1_201911200727/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S2173574319301121"
    "issn" => "21735743"
    "doi" => "10.1016/j.reumae.2017.08.011"
    "estado" => "S300"
    "fechaPublicacion" => "2019-11-01"
    "aid" => "1122"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and Sociedad Espa&#241;ola de Reumatolog&#237;a y Colegio Mexicano de Reumatolog&#237;a"
    "documento" => "simple-article"
    "crossmark" => 1
    "subdocumento" => "crp"
    "cita" => "Reumatol Clin. 2019;15:e128-e129"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 1
      "HTML" => 1
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Case Report</span>"
      "titulo" => "Haemothorax in vascular Ehlers-Danlos syndrome"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "e128"
          "paginaFinal" => "e129"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Hemot&#243;rax en s&#237;ndrome de Ehlers-Danlos tipo vascular"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Fig&#46; 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 1216
              "Ancho" => 1267
              "Tamanyo" => 114300
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">CT image of the thorax&#44; sagittal view&#46; The internal mammary artery and the haematoma that originates from its rupture can be observed&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Kevin &#193;lvarez, Jordi L&#243;pez, Jose Angel Hern&#225;ndez"
          "autores" => array:3 [
            0 => array:2 [
              "nombre" => "Kevin"
              "apellidos" => "&#193;lvarez"
            ]
            1 => array:2 [
              "nombre" => "Jordi"
              "apellidos" => "L&#243;pez"
            ]
            2 => array:2 [
              "nombre" => "Jose Angel"
              "apellidos" => "Hern&#225;ndez"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S1699258X17302334"
        "doi" => "10.1016/j.reuma.2017.08.009"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X17302334?idApp=UINPBA00004M"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574319301121?idApp=UINPBA00004M"
    "url" => "/21735743/0000001500000006/v1_201911250632/S2173574319301121/v1_201911250632/en/main.assets"
  ]
  "itemAnterior" => array:18 [
    "pii" => "S2173574319301522"
    "issn" => "21735743"
    "doi" => "10.1016/j.reumae.2017.09.008"
    "estado" => "S300"
    "fechaPublicacion" => "2019-11-01"
    "aid" => "1129"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and Sociedad Espa&#241;ola de Reumatolog&#237;a y Colegio Mexicano de Reumatolog&#237;a"
    "documento" => "simple-article"
    "crossmark" => 1
    "subdocumento" => "crp"
    "cita" => "Reumatol Clin. 2019;15:e122-e124"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 1
      "HTML" => 1
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>"
      "titulo" => "Treatment of Persistent Cutaneous Atrophy After Corticosteroid Injection With Fat Graft"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "e122"
          "paginaFinal" => "e124"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Tratamiento de la atrofia e hipopigmentaci&#243;n cut&#225;nea secundaria a infiltraci&#243;n de corticosteroides con injerto de grasa"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Fig&#46; 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 642
              "Ancho" => 1299
              "Tamanyo" => 92082
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Skin hypopigmentation and subcutaneous fat atrophy in the right elbow of the patient after corticosteroid injections&#59; &#40;B&#41; elbow surface 24 months after fat graft&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "N&#225;dia Martins, Joaquim Polido-Pereira, Manuel Caneira, Jo&#227;o Eurico Fonseca"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "N&#225;dia"
              "apellidos" => "Martins"
            ]
            1 => array:2 [
              "nombre" => "Joaquim"
              "apellidos" => "Polido-Pereira"
            ]
            2 => array:2 [
              "nombre" => "Manuel"
              "apellidos" => "Caneira"
            ]
            3 => array:2 [
              "nombre" => "Jo&#227;o Eurico"
              "apellidos" => "Fonseca"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574319301522?idApp=UINPBA00004M"
    "url" => "/21735743/0000001500000006/v1_201911250632/S2173574319301522/v1_201911250632/en/main.assets"
  ]
  "en" => array:20 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Case Report</span>"
    "titulo" => "Gonococcal arthritis and C2 deficiency"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "e125"
        "paginaFinal" => "e127"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Diego Benavent N&#250;&#241;ez, Carolina Tornero Mar&#237;n, Gema Bonilla Hern&#225;n, Adela Garc&#237;a Perea, Alejandro Balsa Criado, Alicia Rico Nieto"
        "autores" => array:6 [
          0 => array:4 [
            "nombre" => "Diego"
            "apellidos" => "Benavent N&#250;&#241;ez"
            "email" => array:1 [
              0 => "d_benavent@hotmail.com"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Carolina"
            "apellidos" => "Tornero Mar&#237;n"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Gema"
            "apellidos" => "Bonilla Hern&#225;n"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "Adela"
            "apellidos" => "Garc&#237;a Perea"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "Alejandro"
            "apellidos" => "Balsa Criado"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          5 => array:3 [
            "nombre" => "Alicia"
            "apellidos" => "Rico Nieto"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:2 [
          0 => array:3 [
            "entidad" => "Servicio de Reumatolog&#237;a&#44; Hospital Universitario La Paz&#44; Madrid&#44; Spain"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Servicio de Microbiolog&#237;a&#44; Hospital Universitario La Paz&#44; Madrid&#44; Spain"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Artritis gonoc&#243;cica y d&#233;ficit de C2"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 819
            "Ancho" => 900
            "Tamanyo" => 91749
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Arthritis of both carpi with tenosynovitis&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Disseminated gonococcal disease &#40;DGD&#41; is an infection caused by <span class="elsevierStyleItalic">Neisseria gonorrhoeae</span> &#40;<span class="elsevierStyleItalic">N&#46; gonorrhoeae</span>&#41; that is transmitted by sexual contact and principally produces joint manifestations&#46; It can appear as the typical triad of polyarthralgia&#44; rash and tenosynovitis or as purulent arthritis without other lesions&#46; Both presentations can overlap or progress from one to the other&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Clinical observation</span><p id="par0010" class="elsevierStylePara elsevierViewall">A 64-year-old female&#44; with no known drug allergies&#46; A medical history of recurrent bronchitis in youth&#46; Operated for a left Colles&#8217; fracture&#46; No regular medical treatment&#46; She attended the emergency department due to a 4-day history of pain and oligoarticular inflammation associated with liquid stools and sensation of dysthermia&#44; with no other associated symptoms&#46; No skin lesions&#46; Last sexual intercourse was one week earlier with usual partner&#46; No recent travel&#46; No domestic animals&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">On physical examination&#44; fair general condition&#44; afebrile&#44; blood pressure 130&#47;76<span class="elsevierStyleHsp" style=""></span>mmHg&#44; heart rate 107 beats per minute&#46; Important inflammatory signs &#40;oedema&#44; erythema&#44; heat and functional limitation&#41; of both carpi &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#44; second metatarsophalangeal joint and left sternoclavicular joint were observed&#46; No rash&#44; adenopathies&#44; oral and&#47;or genital ulcers&#44; or skin lesions&#46; The rest of the examination was normal&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Laboratory tests revealed leukocytosis &#40;20&#44;900&#47;&#956;L&#41; with neutrophilia&#44; elevation of inflammatory parameters &#40;erythrocyte sedimentation rate 115<span class="elsevierStyleHsp" style=""></span>mm&#47;h and C reactive protein 200<span class="elsevierStyleHsp" style=""></span>mg&#47;L&#41; and renal failure &#40;creatinine 2&#46;27<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#41;&#46; High-resolution ultrasound of the swollen joints and magnetic resonance imaging of the left carpus confirmed the presence of polyarthritis&#44; tendosynovitis and paratendonitis&#46; Arthrocentesis of carpus was performed&#44; obtaining a very small amount of purulent synovial fluid that was sent for culture&#46; Blood cultures&#44; stool culture&#44; urine culture and polymerase chain reaction were performed for <span class="elsevierStyleItalic">C&#46; trachomatis</span>&#44; <span class="elsevierStyleItalic">N&#46; gonorrhoeae</span> and <span class="elsevierStyleItalic">T&#46; vaginalis</span> in urine&#44; serologies &#40;HIV&#44; syphilis&#44; hepatitis A&#44; B and C&#44; cytomegalovirus&#44; Epstein Barr virus&#44; herpes virus&#41;&#44; cervical and vaginal sampling for culture and detection of <span class="elsevierStyleItalic">T&#46; vaginalis</span>&#44; <span class="elsevierStyleItalic">Mycoplasma&#47;Ureaplasma</span>&#44; <span class="elsevierStyleItalic">N&#46; gonorrhoeae</span>&#46; Given the clinical findings and the appearance of the joint fluid&#44; empirical treatment was started with cloxacillin and intravenous ceftriaxone&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">N&#46; gonorrhoeae</span> was isolated 24<span class="elsevierStyleHsp" style=""></span>h later in the joint fluid&#44; and the antibiotherapy was adjusted with ceftriaxone 2<span class="elsevierStyleHsp" style=""></span>g&#47;24<span class="elsevierStyleHsp" style=""></span>h and azithromycin 1<span class="elsevierStyleHsp" style=""></span>g in a single dose&#46; The strain showed sensitivity to ceftriaxone&#44; cefixime and ciprofloxacin&#46; In addition&#44; the polymerase chain reaction amplified the <span class="elsevierStyleItalic">N&#46; gonorrhoeae</span> genome in urine&#46; Blood cultures&#44; stool cultures and serology were negative&#46; The autoimmune study was negative&#46; Total haemolytic complement &#40;CH50&#41; was zero&#44; and C2 complement fraction was not detected&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Our patient was diagnosed with disseminated gonococcal disease&#44; showing a combination of arthralgia&#44; tenosynovitis and polyarticular purulent arthritis&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">After 2 weeks of treatment with ceftriaxone&#44; the patient improved clinically and analytically&#44; but presented beta-lactam-induced toxicoderma&#44; and ceftriaxone was substituted with quinolones&#46; The patient received 8 weeks of antibiotic treatment with complete resolution of the infectious process&#46; On discharge&#44; vaccination against capsulated germs was recommended&#46; Follow-up at 12 months showed that the disease had been cured&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0040" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">N&#46; gonorrhoeae</span> is an aerobic gram-negative diplococcus&#44; a human pathogen that is transmitted by direct contact with the urogenital&#44; anal and oropharyngeal tracts&#44; causing local infection<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> or invasive disease&#44; known as DGD&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> DGD includes signs such as polyarthralgia&#44; tenosynovitis and rash&#44; which is the classical triad&#44; or true arthritis&#44; usually monoarticular&#44; associated with positive synovial fluid cultures&#46; Joint involvement in any of the forms appears in 42&#37;&#8211;85&#37; of cases of DGD&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> The polyarthralgias of the classical triad present asymmetrically&#59; tenosynovitis is a more specific finding &#40;50&#37;&#8211;60&#37; of patients&#41;&#44; which leads to pain&#44; swelling and periarticular erythema&#59; skin involvement entails pustules or vesiculopustular lesions&#44; classically distributed in the distal area of the extremities&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> Presentation as arthritis is acute onset&#44; affecting the knees&#44; wrists or ankles&#44; and sternoclavicular arthritis is a rare form of presentation&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> Although the forms of presentation are usually differentiated&#44; there may be overlap between them&#46; In our case&#44; in addition to the age of presentation&#44; which was not usual since it generally affects young and healthy people&#44; the patient&#39;s symptoms attracted our attention&#46; A combination of the different clinical manifestations appeared simultaneously&#44; with polyarthralgias&#44; tenosynovitis and purulent oligoarthritis with positive culture&#44; in addition to involvement of the sternoclavicular joint&#44; which is infrequent&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Some factors predispose to the dissemination of <span class="elsevierStyleItalic">N&#46; gonorrhoeae</span>&#44; such as pregnancy&#44;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> HIV infection&#44; lupus<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> or late complement factor deficiencies&#44;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> association with C2 deficit&#44; as in our case&#44; is rare&#46; On reviewing the literature&#44; we only found 2 cases where a deficit of this complement factor<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">8&#44;9</span></a> was associated with DGD&#46; This fact is striking&#44; since the susceptibility of C2 deficient individuals to infections by other encapsulated bacteria is well known&#46; As previously suggested&#44; DGD is a potential indication for the study of complement deficiencies&#44; and our case is further evidence for this recommendation&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">A diagnosis of DGD is based on clinical symptoms&#44; compatible epidemiology and isolation of <span class="elsevierStyleItalic">N&#46; gonorrhoeae</span> from joint fluid and&#47;or blood cultures by culture or genome detection by polymerase chain reaction&#46; The treatment of choice is ceftriaxone 2<span class="elsevierStyleHsp" style=""></span>g&#47;day for 7&#8211;10 days for disseminated disease&#44; which can be changed to cefixime or oral quinolones if progress is favourable&#46; Culture and antibiogram are recommended&#44; as up to 30&#37; of <span class="elsevierStyleItalic">N&#46; gonorrhoeae</span> strains in our environment are resistant to quinolones&#44; and 5&#37; to third generation cephalosporins&#46; Azithromycin 1<span class="elsevierStyleHsp" style=""></span>g &#40;single dose&#41; should be added due to the risk of other associated STDs&#46; In the case of gonoccocal arthritis treatment should be prolonged for a few weeks&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conclusions</span><p id="par0055" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">N&#46; gonorrhoeae</span> infection is an STD that constitutes a public health problem and is included in the group of Obligatory Declaration Diseases&#46; In the presence of mono- or oligoarticular symptoms with associated tenosynovitis&#44; differential diagnosis with DGD is important for the appropriate treatment and control of the disease&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Ethical responsibilities</span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Protection of people and animals</span><p id="par0060" class="elsevierStylePara elsevierViewall">The authors declare that neither human nor animal testing has been carried out under this research&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Data confidentiality</span><p id="par0065" class="elsevierStylePara elsevierViewall">The authors declare that they have complied with their work centre protocols for the publication of patient data&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Right to privacy and informed consent</span><p id="par0070" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Financing</span><p id="par0075" class="elsevierStylePara elsevierViewall">The authors have received no funding&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Conflict of interests</span><p id="par0080" class="elsevierStylePara elsevierViewall">The authors have no conflict of interests to declare&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:12 [
        0 => array:3 [
          "identificador" => "xres1268385"
          "titulo" => "Abstract"
          "secciones" => array:1 [
            0 => array:1 [
              "identificador" => "abst0005"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec1173986"
          "titulo" => "Keywords"
        ]
        2 => array:3 [
          "identificador" => "xres1268386"
          "titulo" => "Resumen"
          "secciones" => array:1 [
            0 => array:1 [
              "identificador" => "abst0010"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec1173985"
          "titulo" => "Palabras clave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Clinical observation"
        ]
        6 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Discussion"
        ]
        7 => array:2 [
          "identificador" => "sec0020"
          "titulo" => "Conclusions"
        ]
        8 => array:3 [
          "identificador" => "sec0025"
          "titulo" => "Ethical responsibilities"
          "secciones" => array:3 [
            0 => array:2 [
              "identificador" => "sec0030"
              "titulo" => "Protection of people and animals"
            ]
            1 => array:2 [
              "identificador" => "sec0035"
              "titulo" => "Data confidentiality"
            ]
            2 => array:2 [
              "identificador" => "sec0040"
              "titulo" => "Right to privacy and informed consent"
            ]
          ]
        ]
        9 => array:2 [
          "identificador" => "sec0045"
          "titulo" => "Financing"
        ]
        10 => array:2 [
          "identificador" => "sec0050"
          "titulo" => "Conflict of interests"
        ]
        11 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2017-03-17"
    "fechaAceptado" => "2017-08-10"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1173986"
          "palabras" => array:4 [
            0 => "Disseminated gonococcal infection"
            1 => "Gonococcus"
            2 => "Complement"
            3 => "Sternoclavicular arthritis"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1173985"
          "palabras" => array:4 [
            0 => "Enfermedad gonoc&#243;cica diseminada"
            1 => "Gonococo"
            2 => "Complemento"
            3 => "Artritis esternoclavicular"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Disseminated gonococcal infection is a rare presentation of the sexually transmitted pathogen&#44; <span class="elsevierStyleItalic">Neisseria gonorrhoeae</span>&#46; Here&#44; we report the case of a 64-year-old woman with disseminated gonococcal infection&#44; which started with symptoms of oligoarthritis and malaise&#46; <span class="elsevierStyleItalic">Neisseria gonorrhoeae</span> was identified in the carpal synovial fluid&#46; The follow-up study revealed an absence of total hemolytic complement and complement C2 was not detected&#46; Being relatively common&#44; C2 deficiency has been associated with disseminated gonococcal infection in a few cases&#46; We present a new case and discuss those previously published&#46;</p></span>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">La enfermedad gonoc&#243;cica diseminada es una manifestaci&#243;n infrecuente de la afectaci&#243;n por <span class="elsevierStyleItalic">Neisseria gonorrhoeae</span>&#44; que presenta una cl&#237;nica variada y no bien definida&#44; siendo la afectaci&#243;n articular un hallazgo caracter&#237;stico&#46; Presentamos el caso de una mujer de 64 a&#241;os con enfermedad gonoc&#243;cica diseminada de inicio agudo&#44; que comenz&#243; con deterioro generalizado y oligoartritis&#46; Se realiz&#243; artrocentesis de carpo&#44; obteni&#233;ndose un l&#237;quido sinovial de aspecto purulento&#44; cuyo estudio microbiol&#243;gico identific&#243; <span class="elsevierStyleItalic">Neisseira gonorrhoeae</span>&#46; En el estudio se objetiv&#243; un complemento hemol&#237;tico total &#40;CH50&#41; de cero&#44; no detect&#225;ndose la fracci&#243;n C2 del complemento&#46; Son muy pocos los casos descritos en la literatura de enfermedad gonoc&#243;cica diseminada asociada a d&#233;ficit de C2&#46; Presentamos un nuevo caso y revisamos los previamente publicados&#46;</p></span>"
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Benavent N&#250;&#241;ez D&#44; Tornero Mar&#237;n C&#44; Bonilla Hern&#225;n G&#44; Garc&#237;a Perea A&#44; Balsa Criado A&#44; Rico Nieto A&#46; Artritis gonoc&#243;cica y d&#233;ficit de C2&#46; Reumatol Clin&#46; 2019&#59;15&#58;e125&#8211;e127&#46;</p>"
      ]
    ]
    "multimedia" => array:1 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 819
            "Ancho" => 900
            "Tamanyo" => 91749
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Arthritis of both carpi with tenosynovitis&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:10 [
            0 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Antimicrobial resistance expressed by <span class="elsevierStyleItalic">Neisseria gonorrhoeae</span>&#58; a major global public health problem in the 21st century"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46; Unemo"
                            1 => "C&#46; del Rio"
                            2 => "W&#46;M&#46; Shafer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1128/microbiolspec.EI10-0009-2015"
                      "Revista" => array:3 [
                        "tituloSerie" => "Microbiol Spectr"
                        "fecha" => "2016"
                        "volumen" => "4"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The biology of Neisseria adhesins"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "M&#46;-C&#46; Hung"
                            1 => "M&#46; Christodoulides"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3390/biology2031054"
                      "Revista" => array:5 [
                        "tituloSerie" => "Biology &#40;Basel&#41;"
                        "fecha" => "2013"
                        "volumen" => "2"
                        "paginaInicial" => "1054"
                        "paginaFinal" => "1109"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Septic arthritis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46; Garc&#237;a-Arias"
                            1 => "A&#46; Balsa"
                            2 => "E&#46;M&#46; Mola"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.berh.2011.02.001"
                      "Revista" => array:6 [
                        "tituloSerie" => "Best Pract Res Clin Rheumatol"
                        "fecha" => "2011"
                        "volumen" => "25"
                        "paginaInicial" => "407"
                        "paginaFinal" => "421"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22100289"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Gonococcal polyarthritis with sternoclavicular joint involvement in pregnant woman&#58; a case report"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "I&#46; El Mezouar"
                            1 => "L&#46; Tahiri"
                            2 => "F&#46; Lazrak"
                            3 => "K&#46; Berrada"
                            4 => "T&#46; Harzy"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.11604/pamj.2014.17.242.4181"
                      "Revista" => array:5 [
                        "tituloSerie" => "Pan Afr Med J"
                        "fecha" => "2014"
                        "volumen" => "17"
                        "paginaInicial" => "242"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25170386"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Gonorrhoea infection presenting in pregnancy with septic arthritis of the sternoclavicular joint"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "A&#46;J&#46; O&#8217;Leary"
                            1 => "H&#46; Tejura"
                            2 => "M&#46; Latibeaudiere"
                            3 => "G&#46; Edwards"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1080/01443610600618614"
                      "Revista" => array:6 [
                        "tituloSerie" => "J ObstetGynaecol"
                        "fecha" => "2006"
                        "volumen" => "26"
                        "paginaInicial" => "373"
                        "paginaFinal" => "374"
                        "itemHostRev" => array:3 [
                          "pii" => "S0738081X13002976"
                          "estado" => "S300"
                          "issn" => "0738081X"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:1 [
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "T&#46; Bardin"
                            1 => "Gonococcalarthritis"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/s1521-6942(02)00125-0"
                      "Revista" => array:6 [
                        "tituloSerie" => "Best Pract Res Clin Rheumatol"
                        "fecha" => "2003"
                        "volumen" => "17"
                        "paginaInicial" => "201"
                        "paginaFinal" => "208"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12787521"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Infectious diseases associated with complement deficiencies"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46;E&#46; Figueroa"
                            1 => "P&#46; Densen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1128/cmr.4.3.359"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Microbiol Rev"
                        "fecha" => "1991"
                        "volumen" => "4"
                        "paginaInicial" => "359"
                        "paginaFinal" => "395"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1889047"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Disseminated gonococcal infection associated with deficiency of the second component of complement"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "P&#46;H&#46;M&#46; Mcwhinney"
                            1 => "P&#46; Langhorne"
                            2 => "W&#46;C&#46; Love"
                            3 => "&#8217;K&#46; Whaley"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Postgr Med J"
                        "fecha" => "1991"
                        "volumen" => "67"
                        "paginaInicial" => "297"
                        "paginaFinal" => "298"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Disseminated gonococcal infection in an elderly patient"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "I&#46; Rua Figueroa"
                            1 => "E&#46; Loza Cortina"
                            2 => "S&#46; Gonz&#225;lez Su&#225;rez"
                            3 => "C&#46; Erausqu&#237;nArruabarrena"
                            4 => "J&#46;L&#46; Pe&#241;a Sagredo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Ann Rheum Dis"
                        "fecha" => "1993"
                        "volumen" => "19"
                        "paginaInicial" => "629"
                        "paginaFinal" => "636"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Underlying complement deficiency in patients with disseminated gonococcal infection"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "R&#46;T&#46; Ellison"
                            1 => "J&#46;G&#46; Curd"
                            2 => "P&#46;F&#46; Kohler"
                            3 => "L&#46;B&#46; Reller"
                            4 => "F&#46;N&#46; Juckson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/00007435-198710000-00004"
                      "Revista" => array:6 [
                        "tituloSerie" => "Sex Transm Dis"
                        "fecha" => "1987"
                        "volumen" => "14"
                        "paginaInicial" => "201"
                        "paginaFinal" => "204"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2830678"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/21735743/0000001500000006/v1_201911250632/S2173574319301145/v1_201911250632/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "80960"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Cases report"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/21735743/0000001500000006/v1_201911250632/S2173574319301145/v1_201911250632/en/main.pdf?idApp=UINPBA00004M&text.app=https://reumatologiaclinica.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574319301145?idApp=UINPBA00004M"
]