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Young Woman With Atypical Presentation of Fitz-Hugh-Curtis Syndrome

Fitz-Hugh-Curtis syndrome is not well known, but it is classified as an emergent condition by the Model of the Clinical Practice of Emergency Medicine. As described in multiple case reports, the typical presentation includes right upper quadrant pain that may be pleuritic in young, sexually active women. About 50% to 75% of cases are caused by Chlamydia trachomatis infection, whereas only 10% result from N gonorrhoeae infection, as occurred in this patient. Fitz-Hugh-Curtis syndrome has also been implicated as a complication of pelvic inflammatory disease in 5% to 10% of cases...

There is no consensus in the literature regarding the utility and selection of an imaging modality…

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 Fitz-Hugh-Curtis and Peritonitis: Sorting Through the Features that Define This Syndrome

Fitz-Hugh–Curtis syndrome (FHCS) is defined by the sign of perihepatic (violin-string) adhesions extending from the parietal peritoneum of the anterior abdominal wall to the anterior liver (Glisson) capsule and symptoms of right upper quadrant abdominal pain as well as those, most commonly, referable to a pelvic inflammatory disease (PID) process.

 POTD: Young woman with upper abdominal pain clinical vignette

Outpatient treatment for Fitz-Hugh-Curtis syndrome is similar to that for PID: ceftriaxone, 250 mg IM once, and doxycycline, 100 mg PO twice daily for 14 days, with or without metronidazole, 500 mg PO twice daily for 14 days. Patients who are hemodynamically stable may be discharged home with OBGYN f/u.

Articles of Interest

Chlamydia trachomatis-Induced Fitz-Hugh-Curtis Syndrome Presenting as Inspiratory Dyspnea

Fitz-Hugh-Curtis syndrome (FHCS) is known as the great mimicker of acute cholecystitis; therefore, often times this diagnosis may be missed. In patients with pelvic inflammatory disease (PID),

Chlamydia trachomatis-induced Fitz-Hugh–Curtis syndrome: a case report

Fitz-Hugh–Curtis syndrome is defined as perihepatitis associated with pelvic inflammatory disease. Chlamydia trachomatis is one of its most common aetiologies. This syndrome usually presents with right upper quadrant abdominal pain mimicking other hepatobiliary and gastrointestinal pathologies, hence, posing a diagnostic dilemma in settings with limited diagnostic tools.

Fitz Hugh Curtis Case Report

Fitz-Hugh Curtis syndrome (FHCS) is a rare sequela of pelvic inflammatory disease that must be included on the differential in patients with abdominal pain, particularly if they have risk factors for sexually transmitted infections.

Fitz-Hugh-Curtis Syndrome Presenting as Acute Abdomen

Laparoscopy is the criterion standard for diagnosis of pelvic inflammatory disease. Fitz-Hugh-Curtis syndrome is a complication of approximately 25% of patients with pelvic inflammatory disease, characterized by “violin-string” perihepatic inflammation. Treatment with cefoxitin, doxycycline, and metronidazole led to resolution within 2 weeks.

Fitz-Hugh-Curtis syndrome: A diagnosis to consider in women with right upper quadrant pain

Fitz-Hugh-Curtis syndrome—inflammation of the liver capsule associated with genital tract infection—occurs in up to one fourth of patients with pelvic inflammatory disease (PID). Classically presenting as sharp, pleuritic right upper quadrant pain, usually but not always accompanied by signs of salpingitis, it can mimic many other common disorders such as cholecystitis and pyelonephritis.

Fitz-hugh-curtis syndrome: A rare disease in the differential diagnosis of acute abdomen

FHCS is an uncommon condition of the perihepatic capsule inflammation secondary to PID . The mechanism of the inflammation is thought to result from the direct intraperitoneal spread of infection towards the perihepatic region from initial pelvic inflammation

Right Upper Quadrant Pain in a Young Woman Isn't Always Biliary in Origin: A Case of Fitz-Hugh–Curtis Syndrome (FHCS)

FHCS usually presents with RUQ abdominal pain that mimics hepatobiliary etiologies, and usually is associated with symptoms of PID including pelvic/lower abdominal pain, vaginal discharge or CMT.

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Life in the Fastlane

The condition most commonly (but not exclusively) occurs in females with pelvic inflammatory disease/salpingitis infected with Chlamydia trachomatis or Neisseria gonorrhoeae the commonly defined causative organisms.

Fitz-Hugh-Curtis Syndrome: A Diagnosis to Consider in a Woman with Right Upper Quadrant Abdominal Pain without Gallstones

FHCS is localized inflammation of the peritoneum associated with an ascending genital infection[1-3]. Typical lesions are the so-called ‘violin string adhesions’, which are peritoneal adhesions between the diaphragm’s right dome and the anterior surface of the liver capsule[4-3]. The liver itself is not involved, hence the term ‘perihepatitis’. This condition is considered to be a complication of PID and sometimes may be its only sign.

NORD

Fitz-Hugh-Curtis syndrome is a rare disorder that occurs almost exclusively in women. It is characterized by inflammation of the membrane lining the stomach (peritoneum) and the tissues surrounding the liver (perihepatitis).

ScienceDirect

The classic manifestation of perihepatitis, or Fitz-Hugh–Curtis syndrome, is severe right upper abdominal pain that often radiates to the shoulder. Concurrent left upper abdominal pain also may be present. Lower abdominal pain and evidence of acute or subacute PID are frequent findings.

StatPearls

Fitz-Hugh-Curtis syndrome (FHCS), or perihepatitis, is a chronic manifestation of pelvic inflammatory disease (PID). It is described as an inflammation of the liver capsule, without the involvement of the liver parenchyma, with adhesion formation accompanied by right upper quadrant pain.