Identification of Neisseria gonorrhoeae in Synovial Membrane by Electron Microscopy

Abstract

A paucity of information exists regarding the histopathology of early gonococcal arthritis. Synovial tissue from a patient with gonococcal arthritis of two days' duration was examined by light and electron microscopy. Neisseria gonorrhoeae was cultured from synovial fluid but not from the biopsied membrane, although gram-negative diplococci were demonstrated in synovial lining cells. After staining with hematoxylin and eosin, only minimal inflammation limited to margination of polymorphonuclear leukocytes in vessels and hypertrophy of the lining cell layer was visible. Electron microscopy of the tissue showed many organisms in the type A phagocytic lining cells and some in the extracellular spaces. While extracellular organisms appeared to be mainly intact, intracellular organisms demonstrated morphologic variation, with some degraded forms consistent with wall-defective variants. This is the first demonstration of N. gonorrhoeae in synovial tissue by electron microscopy.