A 25-year-old woman presents with fever, tenosynovitis of the wrist, and a few painless pustules on the dorsum of the hand. Joint aspiration shows Gram-negative diplococci. What is the most likely diagnosis?
- A Acute rheumatic fever
- B Disseminated gonococcal infection ✓
- C Infective endocarditis
- D Reactive arthritis
Correct answer: B. Disseminated gonococcal infection
Explanation
Disseminated gonococcal infection classically presents with tenosynovitis, dermatitis (painless pustules), and polyarthralgia. Gram-negative diplococci in synovial fluid confirm the diagnosis. Rheumatic fever and endocarditis have different skin findings, and reactive arthritis lacks positive Gram stain.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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