A previously healthy, 20-year-old female patient presented to the emergency department
with a two-day history of right upper quadrant (RUQ) pain. The pain worsened with
deep breathing or torso movement in any direction. She noticed a malodorous, greenish
vaginal discharge one month before the current presentation. She had no respiratory,
gastrointestinal or urinary symptoms and reported having regular sexual intercourse
with a single partner using a condom. On presentation, she was hemodynamically stable.
Her body temperature was 37.5 °C, and her other vital signs were normal. Abdominal
examination revealed marked tenderness of the liver. Gynecological examination revealed
no cervical migratory pain. Laboratory tests demonstrated leukocytes 10,200 × 109/L (normal 3,300–8,600 × 109/L) and C-reactive protein 2.97 mg/dL (normal < 0.14 mg/dL). Liver function test results
were normal, and a pregnancy test returned negative. Contrast-enhanced computed tomography
(CT) demonstrated early enhancement along the hepatic surface which was consistent
with Fitz-Hugh Curtis syndrome (Fig. 1). Polymerase chain reaction using an endocervical swab returned positive for Chlamydia trachomatis and negative for Neisseria gonorrhoeae, confirming the diagnosis. Tests for other sexually transmitted diseases were negative.
She received oral azithromycin for 14 days and intravenous, single-dose ceftriaxone.
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References
- CT diagnosis of Fitz-Hugh and Curtis Syndrome: value of the arterial phase scan.Korean J Radiol. 2007; 8: 40-47
- Fitz-Hugh-Curtis syndrome: a diagnosis to consider in women with right upper quadrant pain.Cleve Clin J Med. 2004; 71: 233-239
- Clinical features of Fitz-Hugh-Curtis Syndrome in the emergency department.Yousei Med J. 2012; 53: 753-758
- Subclinical pelvic inflammatory disease and infertility.Obstet Gynecol. 2012; 120: 37-43
Article info
Publication history
Published online: December 18, 2022
Accepted:
December 15,
2022
Received:
August 20,
2022
Identification
Copyright
© 2022 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.
