Neonatal Conjunctivitis with Gram-Negative Diplococci Suggestive of Neisseria gonorrhoeae: A Case Report

Case Report

Abstract

Introduction: Gonococcal conjunctivitis in a neonate is a conjunctival infection caused by Neisseria gonorrhoeae. Transmission commonly occurs during vaginal delivery from an infected mother. This serious infection can threaten vision if not promptly and properly treated. Case: A 14-day-old female infant was brought to the ophthalmology clinic by her parents with a complaint of bilateral eye discharge that had been present since she was 2 days old. The discharge was yellow, thick, and sticky. Ocular examination revealed edema and erythema of the upper eyelids with profuse purulent discharge. The tarsal conjunctiva was hyperemic with positive conjunctival vessel injection (CVI) and membrane formation. Mild corneal edema was observed. The direct pupillary light reflex was present. Gram staining of conjunctival swab specimens obtained from both eyes demonstrated Gram-negative diplococci. The patient was presumptively diagnosed with gonococcal conjunctivitis based on the clinical findings and Gram staining demonstrating Gram-negative diplococci. Treatment included eye toilet with sterile cotton buds, a single intravenous dose of ceftriaxone 25 mg/kg body weight, 0.3% ofloxacin eye drops administered six times daily to both eyes, and artificial tears administered six times daily to both eyes. Discussion: The clinical findings and Gram-stain results support a presumptive diagnosis of gonococcal conjunctivitis, an infection characterized by rapid progression and a high risk of corneal complications. Management with a single dose of ceftriaxone plus topical therapy led to rapid clinical improvement. Conclusion: Prompt diagnosis and treatment of neonatal gonococcal conjunctivitis with systemic and intensive topical antibiotic therapy resulted in a favorable clinical outcome and helped prevent serious ocular complications.