Bilateral gonococcal septic tenosynovitis and septic arthritis as a first presentation of HIV in a 53-year-old male.

Infection with Neisseria gonorrhoeae is common, primarily affecting the urogenital system. Disseminated gonococcal infection (DGI) through the bloodstream is much less common but has important ramifications on the musculoskeletal system, as it can infect tendon sheaths and joints. We describe a case of bilateral gonococcal septic tenosynovitis and septic arthritis with contiguous osteomyelitis in the ankles/feet of a 53-year-old male whose presentation triggered an immunodeficiency workup revealing HIV. This case highlights challenges associated with the diagnosis of DGI, the need for heightened clinical suspicion in patients presenting with septic tenosynovitis, and the importance of recognizing clinical signs of immunodeficiency.