South Dakota medicine : the journal of the South Dakota State Medical Association最新文献

{"title":"Abstract: Recognizing Early Signs of Primary Congenital Glaucoma in Infancy.","authors":"Alexander D M Withrow, Jeffrey Schuch, Michael Frick, David W M Withrow","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Primary congenital glaucoma (PCG) is a rare and vision-threatening condition caused by abnormal development of the anterior chamber angle, leading to impaired aqueous humor outflow and subsequent elevated intraocular pressure. Although uncommon, PCG remains an important cause of irreversible visual impairment in the pediatric population. Early recognition is critical, as delayed diagnosis may result in optic nerve damage, amblyopia, and permanent vision loss. Classic clinical findings include epiphora, photophobia, blepharospasm, corneal clouding, and increased corneal diameter. This report describes an early presentation of PCG in a previously healthy infant and emphasizes the importance of prompt referral and surgical management.</p><p><strong>Case report: </strong>A three-month-old male with no significant past medical history presented to pediatric clinic with a one-day history of progressive eye swelling, cloudy pupils, and fussiness. Patient's mother denied respiratory symptoms, fever, or ocular discharge. Patient was born at term via uncomplicated vaginal delivery. Prior examinations documented normal pupillary responses and bilateral red reflex. On examination, the right eye appeared cloudy with an absent red reflex, prompting same-day referral to pediatric ophthalmology. Evaluation revealed right corneal clouding and elevated intraocular pressures of 26 and 24 mmHg. The patient was started on topical brinzolamide. At follow-up two days later, the corneal clouding had improved; however, intraocular pressures increased to 37 and 45 mmHg. The patient was diagnosed with primary congenital glaucoma and referred to a tertiary pediatric glaucoma center for surgical management. He subsequently underwent bilateral canaloplasty and trabeculotomy with additional revisions and continued ophthalmologic follow-up.</p><p><strong>Conclusion: </strong>This case highlights the importance of rapid identification of primary congenital glaucoma in early infancy. Subtle findings, including corneal clouding and abnormal red reflex, should prompt urgent ophthalmologic evaluation. Early diagnosis and surgical intervention are essential to reduce intraocular pressure, prevent optic nerve damage, and preserve visual function.</p>","PeriodicalId":39219,"journal":{"name":"South Dakota medicine : the journal of the South Dakota State Medical Association","volume":"79 suppl 5","pages":"s28-s29"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148621677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Abstract: Evaluating the Educational Impact of the OSCE 360 Method in Pre-Clerkship Medical Students: A Cross-Sectional Survey Study.","authors":"Carly Alley, Andrew Kremer, Maggie Derner, Arica Schuknecht, Valeriy Kozmenko, Roy Mortinsen","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Traditional Objective Structured Clinical Examinations (OSCEs) primarily assess students in the physician role. The OSCE 360 model expands this framework by incorporating student-authored cases and role rotation (student-doctor, student-patient, and evaluator), promoting experimental learning and exposure to multiple perspectives in patient care. Case writing may enhance clinical reasoning and diagnosis generation, while participation as standardized patients and peer evaluators reinforces understanding of clinical encounters. This study evaluates student perceptions of the educational impact of OSCE 360.</p><p><strong>Methods: </strong>A cross-sectional anonymous Qualtrics survey was administered to pre-clerkship medical students (Class of 2028) following participation in the OSCE 360 sessions. The survey assessed perceived case complexity, number of differential diagnoses considered, learning across roles, and confidence in case-writing. Descriptive statistics were used to summarize responses.</p><p><strong>Results: </strong>Twenty-seven students responded, with 16 completing all items. Most respondents, 87.5%, rated their cases as average to somewhat complex. When writing cases, 81.3% considered three or more differential diagnoses, compared to 56.3% when acting as student-doctor. Most agreed or strongly agreed that writing cases improved medical knowledge and patient management skills by 75.0%. Similarly, 68.8% agreed or strongly agreed that portraying the patient enhanced understanding of symptom presentation and clinical reasoning. Self-assessed case-writing proficiency was most commonly rated as average (75.0%).</p><p><strong>Conclusions: </strong>OSCE 360 is perceived as a valuable educational approach for enhancing clinical reasoning, diagnostic thinking, and understanding of patient presentations through experiential learning. Role rotation and case construction provide meaningful learning beyond traditional OSCE formats. These findings support continued implementation of OSCE 360 and further investigation into its impact on objective performance and longitudinal clinical skill development.</p>","PeriodicalId":39219,"journal":{"name":"South Dakota medicine : the journal of the South Dakota State Medical Association","volume":"79 suppl 5","pages":"s22-s23"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148620880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Abstract: When \"Sepsis\" Means Everything and Nothing: The SEPSIS Dialogue as a Framework for Reconciling Medical Terminology with Family Understanding.","authors":"Mackenzie Gustafson","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>The term sepsis is commonly used in surgical and critical care settings, yet its linguistic and emotional impact on patients' families is underexplored. Misinterpretation can influence perception, critical decision, and heighten fear. This work examines how the diagnosis of sepsis functions as both a physiologic and communicative event, and to propose the SEPSIS Dialogue; a novel, structured framework for family-centered communication in acute surgical care.</p><p><strong>Methods: </strong>Narrative reflection and synthesis integrating surgical physiology, health literacy, and communication ethics. This framework was developed by mapping common communicative friction points in the ICU and perioperative setting against established principles of serious illness conversations.</p><p><strong>Results: </strong>Families frequently interpret sepsis as a fixed, catastrophic outcome, whereas clinicians view it as a dynamic spectrum. In surgical contexts, this \"comprehension gap\" is often widest at critical decision points, such as the need for re-operation. The SEPSIS Dialogue (State mechanism, Explain source, Present the spectrum, Speak to uncertainty, Invite questions, Support emotions, Demonstrate understanding) provides a structured pathway to bridge the gap in ways that respect comprehension, emotional experience, and clinical context.</p><p><strong>Conclusion: </strong>Structured, plain-language communication can transform sepsis conversations from fear-driven moments into opportunities for partnership, clarity, and informed, values-based care.</p>","PeriodicalId":39219,"journal":{"name":"South Dakota medicine : the journal of the South Dakota State Medical Association","volume":"79 suppl 5","pages":"s31"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148621779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increased Risk of Alcohol Use Disorder Following Bariatric Surgery.","authors":"Avery D Franzen, Jadah Bartow, Hannah Statz DeVries","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Obesity affects over 40% of adults in the U.S., and bariatric surgery, particularly Roux-en-Y gastric bypass (RYGB), is among the most effective treatments for sustained weight loss and comorbidity reduction. However, emerging evidence has linked bariatric surgery to an increased risk of alcohol use disorder (AUD), particularly in the years following surgery.</p><p><strong>Objective: </strong>To review the evidence surrounding the incidence, timing, mechanisms, and risk factors associated with AUD following bariatric surgery, with an emphasis on RYGB.</p><p><strong>Methods: </strong>A comprehensive review of the literature examining postoperative rates of AUD among bariatric surgery patients was conducted, highlighting trends, mechanisms, and subpopulations at risk.</p><p><strong>Results: </strong>RYGB is associated with a significantly increased risk of developing AUD, with incidence rising notably 2-8 years postoperatively. Risk factors include younger age, male gender, preoperative substance use, poor mental health, low social support, and undergoing RYGB rather than other surgical procedures. The delayed increase in AUD appears to result from both physiological changes such as faster alcohol absorption and higher peak blood alcohol levels and psychological factors like addiction transfer. Additionally, bariatric surgery increases risks for alcohol-related liver disease and psychiatric hospitalization related to alcohol misuse.</p><p><strong>Conclusion: </strong>AUD is a significant long-term risk following RYGB, warranting routine preoperative screening, patient education, and long-term postoperative monitoring. Use of validated screening tools and provision of behavioral health support are critical to mitigate this risk and ensure optimal long-term outcomes for bariatric surgery patients.</p>","PeriodicalId":39219,"journal":{"name":"South Dakota medicine : the journal of the South Dakota State Medical Association","volume":"79 5","pages":"207-210"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148621818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Abstract: Nurturing Equity in Screening for Perinatal Treatment (NEST).","authors":"Abigail Erkonen, Anna Strahm","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Depression during pregnancy is an important public health concern, with national recommendations calling for universal screening throughout prenatal care. However, recent analysis within the Sanford Health system (2011-2021) found that depression during pregnancy was diagnosed in 11.20% of all pregnancies but in only 4.55% of Black pregnancies, suggesting underdiagnosis in this population. This study aims to identify barriers to effective prenatal depression screening for Black women and assess potential solutions to improve provider practices and patient outcomes. This qualitative study will involve up to 25 semi-structured informational interviews with prenatal care providers within the Sanford Health system. Providers will be recruited via email using a voluntary participation approach. Interviews will last 15-20 minutes and be conducted in person or via phone in a private setting. Recruitment will continue until thematic saturation, anticipated within 12-25 interviews. We anticipate identifying several recurring themes representing provider-perceived barriers to screening for depressive symptoms during Black pregnancy. Based on preliminary literature and project rationale, expected themes may include time constraints in clinical workflow, limited training in culturally sensitive screening, differences in patient-provider communication, provider uncertainty regarding follow-up procedures, and perceived stigma surrounding mental health. Additional themes may reflect systemic, cultural, or institutional gaps that influence screening practices across clinics. Identifying provider-perceived barriers will inform targeted recommendations for improving depression screening during Black pregnancy within the Great Plains region. Insights from this study may guide development of provider training initiatives, workflow modifications, and system-level supports that promote equitable mental health screening. Ultimately, this work aims to support earlier identification and treatment of depression, reduce disparities in prenatal care, and strengthen culturally responsive practices within regional health systems.</p>","PeriodicalId":39219,"journal":{"name":"South Dakota medicine : the journal of the South Dakota State Medical Association","volume":"79 suppl 5","pages":"s26-s27"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148621724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Abstract: A Rare Surgical Complication of an Internal Hernia Secondary to Ureter Mobilization from an Ileal Conduit: A Case Report.","authors":"Cole Knoblich, Michael Brozik","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Internal hernias occur when abdominal viscera, such as small bowel loops, protrude through a peritoneal or mesenteric defect into the abdominal or pelvic cavity. The origin of these internal orifices can be congenital, or acquired by inflammation, trauma, or previous surgeries, like gastric bypass. Although internal hernias make up a small portion of small bowel obstructions, that number is slowly increasing due to higher volumes of bariatric surgeries. However, these surgeries are not the only ones that increase patient's risk for internal hernias. Here we present a patient with an internal hernia from ureter mobilization from an ileal conduit.</p><p><strong>Case report: </strong>We present a 46-year-old female with history of cervical cancer and ileal conduit for urinary diversion secondary to a vesicovaginal fistula who presented to our emergency department with acute onset of abdominal pain. An abdominal and pelvic CT showed thick-walled, inflamed, and dilated small bowel loops with concerns for a closed loop obstruction from an internal hernia. She became tachycardic and laboratory studies showed elevated white count and lactic acid. Emergent exploratory laparotomy was recommended. Immediately on inspection, ischemic small bowel with proximal dilation was identified. It became apparent that the patient had an internal hernia as a result of her left ureter being mobilized and anastomosed to her ileal conduit. The threatened bowel was reduced with little difficulty and was visually viable with peristalsis. There was no remaining bowel identified within any internal defects and the patient tolerated the procedure well.</p><p><strong>Conclusion: </strong>Ileal conduits have become a gold standard for urine diversion because of its ease and lower postoperative complications. Defects created often go unclosed which increases the risk for future internal hernias. General surgeons should have increased suspicion for internal hernias in the post-ileal conduit patient who presents with symptoms of bowel obstruction.</p>","PeriodicalId":39219,"journal":{"name":"South Dakota medicine : the journal of the South Dakota State Medical Association","volume":"79 suppl 5","pages":"s36-s37"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148621803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Abstract: Transscaphoid Perilunate Dislocation in a Rural Trauma Patient: A Case Report Highlighting Diagnostic and Management Considerations.","authors":"Emily Wilde, Ryan Peldo, Henry Mullaney, Brooklyn VanDerWolde, Hao Li, Aaron Pemberton, Robert Jr Van Demark","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Perilunate dislocations are uncommon and frequently missed wrist injuries that can lead to significant morbidity, such as median nerve injury, carpal instability, and poor functional outcomes, if not promptly identified and treated. Early recognition and coordinated management are especially important in rural trauma settings where subspecialty resources are limited.</p><p><strong>Case report: </strong>This case describes a 17-year-old male who presented to a rural emergency department following a motorcycle accident. Initial evaluation showed extensive road rash and a gross deformity of the left elbow. Radiographs of the chest, pelvis, left elbow, and right wrist were obtained. The right wrist demonstrated a scaphoid fracture with a perilunate dislocation. A telemedicine consultation was performed with an emergency medicine physician and the patient was transferred for higher-level care. Upon arrival, orthopedic surgery was consulted. Physical exam showed tenderness to palpation and pain with passive wrist motion. Attempted closed reduction of the perilunate injury was unsuccessful. The wrist was splinted, and the orthopedic hand surgeon was consulted. Open reduction of the perilunate dislocation and carpal tunnel release were performed under general anesthesia. A volar approach was performed, with a longitudinal incision made over the palmar aspect of the hand along the radial border of the ring finger. The median nerve was decompressed, a hematoma was removed, and the capitate was reduced back over the lunate with traction, wrist flexion, and direct pressure on the dorsal aspect of the capitate. Reduction was confirmed on orthogonal fluoroscopic views. The wound was irrigated, closed with nylon suture, and a splint was applied. At 2 month follow-up, the patient was doing well and demonstrated stable wrist alignment with interval healing of all injuries.</p><p><strong>Conclusion: </strong>This case highlights the complexity of managing perilunate dislocations in resource-limited healthcare settings and the importance of prompt diagnosis, appropriate care, and timely surgical referral.</p>","PeriodicalId":39219,"journal":{"name":"South Dakota medicine : the journal of the South Dakota State Medical Association","volume":"79 suppl 5","pages":"s41-s42"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148621806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Abstract: A Rare Cause of Chronic Cough and Hemoptysis: Isolated Tracheobronchial Amyloidosis.","authors":"Jeffrey Schuch, Ryder Grantham, Alex Withrow, Michael Pietila","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Amyloidosis comprises a group of disorders characterized by extracellular deposition of misfolded amyloid proteins within tissues and organs. Tracheobronchial amyloidosis is a rare form of localized amyloidosis involving deposition within the tracheobronchial tree and often presents with nonspecific respiratory symptoms that can mimic more common pulmonary diseases. Because of its rarity and variable presentation, diagnosis may be delayed. Increased awareness of this condition is important to facilitate timely recognition and management.</p><p><strong>Case report: </strong>A 49-year-old male presented to a pulmonology clinic with a nine-month history of intermittent cough and hemoptysis. Episodes were characterized by sore throat followed by nonproductive cough, wheezing, dyspnea during coughing spells, and blood-tinged sputum. Symptomatic episodes lasted several weeks and recurred three times over nine months. Prior treatment with antibiotics, corticosteroids, and bronchodilators provided partial relief. Chest radiography demonstrated mild hyperinflation without acute findings, and physical examination revealed rhonchi. Computed tomography of the chest demonstrated irregular thickening of the anterior tracheal wall with calcifications near the level of the aortic arch. Subsequent bronchoscopy revealed a friable papillomatous lesion nearly obstructing the mid-trachea. Biopsy was negative for acid-fast and fungal organisms. Histopathology demonstrated amyloid deposition with apple-green birefringence on Congo red staining. The patient underwent rigid bronchoscopy with successful soft tissue debulking. Follow-up bronchoscopy two months later showed a normal airway without recurrence, and evaluation revealed no evidence of systemic amyloidosis.</p><p><strong>Conclusion: </strong>Tracheobronchial amyloidosis is an uncommon cause of chronic cough and hemoptysis that may mimic other airway diseases. Recognition of characteristic imaging and bronchoscopic findings, along with confirmatory Congo red staining, is essential for diagnosis. Early bronchoscopic intervention can restore airway patency and improve symptoms.</p>","PeriodicalId":39219,"journal":{"name":"South Dakota medicine : the journal of the South Dakota State Medical Association","volume":"79 suppl 5","pages":"s30-s31"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148621838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Abstract: Enhancing Patient Education of Gynecological Conditions with 3D Printing Technologies: Humanities Edition.","authors":"Rilie B Curd, Kiley Medler, Grace Geffre","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Uterine fibroids affect an estimated 70% of women worldwide. Adenomyosis has an estimated prevalence ranging from 8.8% to 61.5% in hysterectomy cases over the past 50 years. Both conditions affect millions, yet remain underdiagnosed and poorly understood by patients. Transvaginal ultrasonography (TVUS) is the first line diagnostic imaging modality for detecting both uterine fibroids and adenomyosis. Despite advancements in diagnostic imaging, 50% of patients with uterine fibroids are unaware of their diagnosis even after TVUS detection, and one third of patients experience diagnostic delays of 5 or more years. Further, traditional 2D imaging such as MRI or ultrasound can be challenging for patients to interpret, potentially hindering understanding and affecting decision-making regarding treatment.</p><p><strong>Case presentation: </strong>A multiparous woman with large uterine fibroids and two prior cesarean sections developed intermittent right lower quadrant pain along her c-section scar which persisted for nine years. Ultrasound and CT imaging repeatedly showed a markedly enlarged, fibroid uterus with no clear etiology. Hysterectomy was suggested as definitive treatment. Using CT data, the patient generated a 3D printed pelvic model of the uterus filling the pelvis, displacing intestines, compressing the bladder and pressing on the rectum. After visualization of this distortion, the patient elected to move forward with a hysterectomy which completely resolved her chronic pain and urinary symptoms.</p><p><strong>Conclusion: </strong>This case underscores the importance of effective education and communication in managing gynecological conditions, especially when patients face complex decisions regarding treatment options such as undergoing a hysterectomy. Further the case emphasizes the possibility of enhancing patient education through 3D printing technology. As the American College of Obstetricians and Gynecologists (ACOG) notes, \"Shared decision-making is a key component of patient-centered care, especially when multiple reasonable management options are available and the best choice depends on patient preferences and values.\"</p>","PeriodicalId":39219,"journal":{"name":"South Dakota medicine : the journal of the South Dakota State Medical Association","volume":"79 suppl 5","pages":"s38-s39"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148621892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Abstract: Disseminated Gonococcal Infection in the Setting of Previous Syphilis: A Diagnostic Dilemma.","authors":"Krishna Suresh, Anna Sunny, Nirmal Muthukumarasamy","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Disseminated gonococcal infection (DGI) is an uncommon but serious complication of untreated Neisseria gonorrhoeae infection, which typically presents as either the classic dermatitis-tenosynovitis-migratory polyarthralgia syndrome or as septic arthritis. Diagnosis is often challenging because blood and synovial cultures are frequently negative.</p><p><strong>Case presentation: </strong>A 35-year-old male with past medical history of recurrent diverticulitis and syphilis, presented with arthritis involving the left knee and ankle, followed by a progressive rash starting on the palms and soles and spreading towards his trunk during a diverticulitis flare. History was notable for multiple sexual partners. Physical examination was significant for multiple skin lesions with variable morphology involving the palms and soles. Left knee joint exam revealed swelling and reduced range of motion. Labs showed elevated inflammatory markers, and reactive RPR of 1:32 with positive treponemal antibodies. Infective workup, including blood cultures, urine Chlamydia/gonorrhea NAAT were negative. Subsequent arthrocentesis of the left knee and left ankle revealed elevated nucleated cells (73,500/µl ankle, 76,250/µl knee) with positive monosodium urate crystals. Notably, broad range synovial PCR was positive for N. gonorrhea but joint cultures negative. He was diagnosed with DGI, and started on IV Ceftriaxone, and received IM Benzathine penicillin G weekly for 3 weeks for concurrent secondary syphilis.</p><p><strong>Discussion: </strong>This case underscores the diagnostic value of targeted molecular testing in DGI, when urine NAAT and cultures are often negative. Since mucosal gonococcal infections are frequently asymptomatic or may have cleared before dissemination, urogenital testing alone may be misleading. Concurrent rash with stable RPR titers and history of prior syphilis raised concern for active secondary infection. This reinforces the need for comprehensive STI screening in all patients with DGI. Lastly, presence of monosodium urate crystals does not exclude septic arthritis. Clinicians should maintain suspicion for DGI in sexually active patients presenting with fever, rash, and arthritis despite initially negative screening tests.</p>","PeriodicalId":39219,"journal":{"name":"South Dakota medicine : the journal of the South Dakota State Medical Association","volume":"79 suppl 5","pages":"s45"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148621894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}