Gonococcaemia with arthritis, dermatitis and myocarditis.

Gonococcaemia with arthritis and dermatitis was described in 1903 by Silvestrini. Subsequent reports, almost all from North America, distinguished two syndromes-one benign, with a mild fever, arthralgia or arthritis, and skin eruptions, and the other a serious illness with often fatal endocarditis (Levin and Silvers, 1937; Reitzel and Kohl, 1938; Williams, 1938). After the introduction of penicillin both syndromes were regarded as rarities until recent years (British Medical Journal, Editorial 1970). Abu-Nassar et al. (1963) drew attention to the specificity of the cutaneous lesion, and the arthritisdermatitis syndrome (Holmes, Wiesnerand Pederson, 1971), or benign gonococcaemia (Wolff, Goodman and Vahrman, 1970), has been increasingly recognized. It is described as a uniformly mild condition responding rapidly to penicillin (Abu-Nassar et al., 1963; Barr and Danielson, 1971). This report describes six patients in Jamaica with gonococcaemia of varying severity-two were seriously ill, including one with myocarditis. Emphasis is placed on early diagnosis.