Vol.74 No.1 January 2026
A case of gonococcal septic arthritis with drug induced fever caused by ceftriaxone that was treated with azithromycin
1)Department of Pharmacy, Nishichita General Hospital, 3-1-1 Nakanoike, Tokai, Aichi, Japan
2)Department of Clinical Laboratory, Nishichita General Hospital
3)Department of Respiratory Medicine, Nishichita General Hospital
4)Department of Orthopedic Surgery, Nishichita General Hospital
Abstract
In Japan, there are few reports of gonococcal septic arthritis and of the use of azithromycin (AZM) in the treatment of gonococcal septic arthritis. A-35-year-old man reported a history of fever and polyarthralgia during an outpatient visit for investigation of the cause of leukocytosis. Neisseria gonorrhoeae was detected on synovial fluid (aspirated from the knee joint) culture, and we made the diagnosis of gonococcal septic arthritis. The fever resolved with ceftriaxone (CTRX), and the serum CRP and arthralgia improved; however, on therapy day 10, the patient developed fever. Since only fever was observed and also resolved 48 h after the antibacterial drug was switched to AZM, we made the diagnosis of drug induced fever caused by CTRX. Subsequently, we treated the patient with AZM for 16 days, which resulted in improvement of the serum CRP levels, joint swelling, and pain. These results suggest that AZM may be a good treatment option for gonococcal septic arthritis in patients who cannot be treated with CTRX. Use of AZM for septic arthritis is not covered by insurance, so that careful judgement is required before administering it.
Key word
disseminated gonococcal infection, Neisseria gonorrhoeae, azithromycin, drug induced fever, septic arthritis
Received
April 8, 2025
Accepted
August 7, 2025
Jpn. J. Chemother. 74 (1): 34-39, 2026
