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Fitz-Hugh Curtis syndrome

Published:December 18, 2022DOI:https://doi.org/10.1016/j.amjms.2022.12.017

      Case presentation

      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.
      Fitz-Hugh Curtis syndrome is a rare cause of RUQ pain in reproductive-aged female patients and consists of perihepatitis complicated by cervicitis or pelvic inflammatory disease. Increased enhancement along the hepatic surface on biphasic contrast-enhanced CT has a high sensitivity and specificity of about 90% each for the disease.
      • Joo SH
      • Kim MJ
      • Lim JS
      • et al.
      CT diagnosis of Fitz-Hugh and Curtis Syndrome: value of the arterial phase scan.
      Liver enzyme levels are usually normal or only slightly elevated,
      • Peter NG
      • Clark LR
      • Jaeger JR.
      Fitz-Hugh-Curtis syndrome: a diagnosis to consider in women with right upper quadrant pain.
      presumably because the inflammation is localized in the liver capsule. Fitz-Hugh Curtis syndrome is mostly caused by a chlamydia or gonococcal infection,
      • You JS
      • Kim MJ
      • Chung HS
      • et al.
      Clinical features of Fitz-Hugh-Curtis Syndrome in the emergency department.
      and history-taking to determine sexual activity is important for its diagnosis. Prompt diagnosis and treatment are important because a genital chlamydia or gonococcal infection can cause infertility.
      • Wiesenfeld HC
      • Hillier SL
      • Meyn LA
      • et al.
      Subclinical pelvic inflammatory disease and infertility.

      Declaration of Competing Interests

      None.

      Funding

      None.

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