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Severe disseminated gonococcal infection with polyarticular gout: 2 case reports In a case report, a 53-year-old man and a 63-year-old man developed severe disseminated gonococcal infection with polyarticular gout following self-medication with indometacin and colchicine, respectively, for presumed gout [routes, dosages and times to reactions onsets not stated]. Case 1: The 53-year-old man had a history of up to 6 episodes/year of acute gout for 10 years along with hazardous alcohol use. He had not been taking preventative therapy for gout. Four days following unprotected sexual intercourse with a commercial sex worker in Manila, Philippines, he developed left ankle pain and swelling, fevers and chills. He self-medicated himself with indometacin [indomethacin] for presumed gout, and the response was noted. Then, he developed polyarthritis, which included the left first metatarsophalangeal joint and ankle, and the metatarsophalangeal joint was noted to have spontaneously discharge pus. In 2013, 10 days after the onset of the symptoms, he presented to hospital in Australia with tenosynovitis of the left elbow, foot, hand and ankle. The left great toe was observed to be erythematous and swollen with open discharge. Also, a mildly tender left para-spinal fluctuant collection was observed. Inflammatory markers, including CRP and leucocytes, were markedly raised. Left foot X-ray revealed soft tissue swelling. Also, the first metatarsophalangeal joint space was observed to be narrowing with bony proliferation, erosions and subchondral cysts, which was consistent with chronic gouty changes. A CT scan revealed a para-vertebral collection adjacent to the spinous processes from T12–L5 levels. Aspirate from the left metatarsophalangeal joint drew pus with leucocytes. Microscopy showed monosodium urate crystals, and β-lactamase-negative Neisseria gonorrhoeae was isolated on culture. He started receiving unspecified antibiotic therapy. Six days later, and a paraspinal collection aspirate was culture-negative; however, Neisseria gonorrhoeae was identified on PCR of the aspirate. Then, he was treated with ceftriaxone with regular unspecified nonsteroidal antiinflammatories [nonsteroidal anti-inflammatory drugs] for acute gout. He underwent incision and drainage of the paraspinal collection, debridement and washout procedures of the left metatarsophalangeal joint, followed by a split-skin graft. Following 42 days of hospitalisation, he was discharged with amoxicillin. He did not follow-up further. He had developed a severe disseminated gonococcal infection with polyarticular gout, which might have been acquired in the Philippines and exacerbated due to indometacin [final outcome not stated]. Case 2: In 2017, the 63-year-old man presented to hospital in Australia with a 10-day history of painful, swollen joints along with fevers, which developed during travel in the Philippines. He had a history of hazardous alcohol use, multiple attacks of gout, obesity and impaired glucose tolerance. He had developed fever and chills, myalgia,