A rare case of miliary tuberculosis accompanying perihepatitis

Perihepatic capsulitis is associated with various diseases, such as Fitz-Hugh-Curtis syndrome, systemic lupus erythematosus, perforated cholecystitis, perforated hepatic abscess, and tuberculous peritonitis. Miliary tuberculosis is present in about 2% of all reported cases of tuberculosis and is characterized by the widespread millet-like hematogenous dissemination of Mycobacterium tuberculosis. We describe a 24-year-old virgin patient presenting with right upper quadrant and costovertebral angle pain. Diffuse perihepatic capsular enhancement was observed in abdominal computed tomography scans. Chest radiography showed miliary tuberculosis, and a polymerase chain reaction hybridization assay of sputum revealed the presence of M. tuberculosis. Symptoms improved after administering anti-tuberculosis medications. This report describes a rare case of miliary tuberculosis accompanying perihepatitis.

A Case of Fitz-Hugh-Curtis syndrome in a male patient / 고신대학교의과대학학술지

Fitz-Hugh-Curtis syndrome has been described as perihepatitis associated with pelvic inflammatory disease (PID). It is classically seen in premenopausal young women who have right upper quadrant pain, usually but not always accompanied by symptoms of PID, and is frequently confused with biliary tract disease. However, the syndrome has rarely been reported in males. The predominant symptom is right upper quadrant pain, but PID may not be present in male patients. Here, we report a case of Fitz-Hugh-Curtis syndrome in a young male patient, which was diagnosed by serological tests and computed tomography. Fitz-Hugh-Curtis syndrome should be considered as a possible cause of pain in the right upper quadrant in male patients, although such a case is very rare.

A Case of Fitz-Hugh-Curtis Syndrome in a Male / 대한소화기학회지

Fitz-Hugh-Curtis syndrome has been described as focal perihepatitis accompanying pelvic inflammatory disease caused by Neisseria gonorrhea and Chlamydia trachomatis. The highest incidence occurs in young, sexually active females. However, the syndrome has been reported to occur infrequently in males, according to the foreign literature. The predominant symptoms are right upper quadrant pain and tenderness, and pleuritic right sided chest pain. The clinical presentation is similar in men and women. In women, the spread of infection to liver capsule is thought to occur directly from infected fallopian tube via the right paracolic gutter. In men, hematogenous and lymphatic spread is thought to be postulated. Recently, we experienced a case of Fitz-Hugh-Curtis syndrome occurred in a man. As far as we know, it is the first report in Korea, and we report a case with a review of the literature.

Two adolescent cases of Fitz-Hugh-Curtis syndrome / 소아과

Two adolescent cases of Fitz-Hugh-Curtis syndrome, which has not been previously reported in Korean girls, presenting with right upper-quadrant abdominal pain, nausea, vomiting, and fever are reported here. A careful and thorough inquiry into the sexual history of the first patient, which was not done upon admission, led to a careful reassessment of the dynamic abdominal computed tomography scan revealing hepatic capsular enhancement without evidence of gallbladder or liver disease. Both cases were diagnosed noninvasively and were treated successfully by medical intervention. A high index of suspicion of Fitz-Hugh-Curtis syndrome should be implemented in the differential diagnosis of right upper quadrant pain, particularly in sexually active girls, for a prompt diagnosis and rapid cure.

Two adolescent cases of Fitz-Hugh-Curtis syndrome / 소아과

Two adolescent cases of Fitz-Hugh-Curtis syndrome, which has not been previously reported in Korean girls, presenting with right upper-quadrant abdominal pain, nausea, vomiting, and fever are reported here. A careful and thorough inquiry into the sexual history of the first patient, which was not done upon admission, led to a careful reassessment of the dynamic abdominal computed tomography scan revealing hepatic capsular enhancement without evidence of gallbladder or liver disease. Both cases were diagnosed noninvasively and were treated successfully by medical intervention. A high index of suspicion of Fitz-Hugh-Curtis syndrome should be implemented in the differential diagnosis of right upper quadrant pain, particularly in sexually active girls, for a prompt diagnosis and rapid cure.

Síndrome de Fitz-Hugh-Curtis como hallazgo durante cirugía ginecológica / Fitz-Hugh-Curtis syndrome: a case report

El síndrome de Fitz-Hugh-Curtis es una perihepatitis producida por una peritonitis secundaria al ascenso de bacterias, como resultado de una enfermedad inflamatoria pélvica. En la etapa crónica se pueden observar adherencias entre la pared abdominal y la superficie hepática, caracterizadas por la semejanza a "cuerdas de violín". Esta imagen es considerada criterio diagnóstico. Se presenta un caso de hallazgo de síndrome de Fitz-Hugh-Curtis, pesquisado durante la inspección rutinaria de la cavidad abdominopélvica, al finalizar una histerectomía laparoscópica.

The Fitz-Hugh-Curtis Syndrome is a perihepatitis secondary to peritonitis caused by ascending bacteria from a pelvic inflammatory disease. During the chronic phase may be observe adherences between the abdominal wall and the liver surface characterized by a "violin string" similarity. This image is considered criterion for the diagnosis. A case of incidental Fitz-Hugh-Curtis syndrome observed during a routinely abdo-minopelvic cavity inspection at the end of a laparoscopic hysterectomy is presented.

Clinical Experiences of Fitz-Hugh-Curtis Syndrome

PURPOSE: Fitz-Hugh-Curtis (FHC) syndrome has been described as perihepatitis associated with pelvic inflammatory disease during surgery. Recently, on computerized tomography a linear enhancement of the liver capsule was detected in a patient with FHC syndrome. We studied to evaluate the clinical course of the disease. METHODS: Sixteen patients diagnosed with FHC syndrome from CT findings were retrospectively studied from April, 2006 to June, 2008. RESULTS: The mean age of the patients was 25.9 (19~35) years and mean duration of abdominal pain was 3.9 (1~14) days. The most common complaint was right upper quadrant area pain (11 cases, 68.8%). 12 patients showed leukocytosis and all the patients had elevated serum C-reative protein levels. All the patients had normal liver function. Among the 9 patients which had polymerase chain reaction test for sexually transmitted disease (Chlamydia trachomatis, Ureaplasma urealyticum, Neisseria gonorrheae, Mycoplasma hominis), all showed more than one positive results (Chlamydia trachomatis 6 cases, Ureaplasma urealyticum 6 cases, Mycoplasma hominis 2 cases). On simple abdomen X-ray, 7 cases (43.8%) showed paralytic ileus. 14 cases received only antibiotic treatment, but 1 case had to take operation (laparoscopic-assisted adhesiolysis) due to constant abdominal pain and prolonged ileus. CONCLUSION: It is important to rule out FHC syndrome by using CT findings, especially young women with right upper abdominal pain and PID. Usually, FHC syndrome can be treated easily with proper antibiotics.

A Case Report of Fitz-Hugh-Curtis Syndrome due to Chlamydia in 19-year-old Woman

Fitz-Hugh-Curtis syndrome (FHCS)-inflammation of the liver capsule (Perihepatitis) associated with genital tract infection-occurs in 4~14% of patients with pelvic inflammatory disease (PID). Generally presenting as sharp, pleuritic right upper quadrant pain, usually but not always accompanied by signs of salpingitis. It needs differential diagnosis such as cholecystitis, pyelonephritis. The pathogenesis of FHCS is incompletely understood. But Neisseria gonorrhoeae and Chlamydia trachomatis are thought to be the primary causative germs of FHCS. We make a report about FHCS in 19-year-old woman who had been sexual history recently.

Clinical feature of Fitz-Hugh-Curtis syndrome: Analysis of 25 cases / 대한간학회지

BACKGROUND/AIMS: Fitz-Hugh-Curtis syndrome is defined as perihepatitis associated with pelvic inflammatory disease (PID). We retrospectively analyzed clinical and laboratory manifestations as well as the therapeutic response in patients with clinically diagnosed Fitz-Hugh-Curtis syndrome. METHODS: A cohort of 25 patients with PID and perihepatitis (as diagnosed by dynamic abdominal computed tomography (CT)) was enrolled. The prognosis, clinical manifestations, and physical examination, laboratory, and CT findings were analyzed. RESULTS: The mean (+/-SD) age of the patients was 32(+/-8) years, and all of them were sexually active, premenopausal women, and presented with abdominal pain. Of these, 52% complained of vaginal discharge. On physical examination, right upper-quadrant tenderness was the most common finding (84%), with lower-abdominal tenderness being present in 20% of patients. On laboratory examination, erythrocyte sedimentation rate and C-reactive protein were increased in 76% and 92% of the patients, respectively. The white blood cell count was increased in 60% of them. Most patients had a normal liver function test. Using a specimen of the cervical discharge, the polymerase chain reaction to test for Chlamydia trachomatis were positive in 87% (13/15) of the patients, and Chlamydia antigen was found in 75% (9/12) of them. Dynamic abdominal CT revealed subcapsular enhancement of the liver in the arterial phase. All of the patients improved with antibiotic therapy. CONCLUSIONS: Symptoms and physical findings suggestive of PID are not present in many patients with Fitz-Hugh-Curtis syndrome. When a premenopausal woman complains of upper abdominal pain and shows CT findings compatible with perihepatitis, examination of cervical discharge would be recommended to assess the possibility of Fitz-Hugh-Curtis syndrome.

Ten Cases of Fitz-Hugh-Curtis Syndrome / 대한소화기학회지

Fitz-Hugh-Curtis syndrome, a kind of perihepatitis, occurs approximately in 3 to 10 percent of patients with pelvic inflammatory disease. It is not easy to detect in clinical settings due to requirement of invasive methods for diagnosis, for example, like a laparoscopic examination. Now, it has become possible to recognize it easily with the aid of non-invasive methods including an abdominal dynamic CT scan and laboratory tests. Moreover, it can be improved after the oral administration of antibiotics. Therefore, noninvasive diagnosis is desirable. Herein, clinical characteristics of ten cases of Fitz-Hugh-Curtis syndrome are reported, with a review of the literature.

A Case of Fitz-Hugh-Curtis Syndrome which have Direct Adhesion between the Liver Capsule and Adjacent Anterior abdominal Wall / 대한산부인과학회지

Fitz-Hugh-Curtis syndrome means perihepatitis consisting of liver capsule inflammation without parenchymal damage associated with pelvic inflammatory disease (PID). The incidence of this syndrome in PID is reported to be 15-30%. It produces right upper quadrant pain from acute inflammatory reaction between liver capsule and adjacent peritoneum in acute phase, and later forms characteristic violin-string adhesions. Recently, it is suggested that marked hepatic subcapsular enhancement at arterial phase in contrast-enhanced CT has diagnostic value, but diagnostic laparoscopy is used as definitive diagnostic method in Fitz-Hugh-Curtis syndrome. We have experienced one case of Fitz-Hugh-Curtis syndrome in women with right upper quadrant pain, which was diagnosed by CT imaging and was not improved by appropriate antibiotic therapy. In diagnostic laparoscopic examination, we have found direct adhesion between liver capsule and anterior abdominal wall and experienced improvement in symptoms after adhesiolysis. So, we report this case with the brief review of the literatures.

Two Cases of FitziHugh-Curtis Syndrome in Acute Phase / 대한소화기학회지

Fitz-Hugh-Curtis syndrome has been defined as perihepatitis accompanying pelvic inflammatory disease caused by Neisseria gonorrhoeae and Chlamydia trachomatis. In the acute phase, patients usually complain of severe right upper quadrant pain of sudden onset. The pain is sharp, pleuritic and most intense at the level of the right lower rib margin and thus it is frequently confused with acute cholecystitis or pleurisy. Definitive diagnosis of Fitz-Hugh-Curtis syndrome needs invasive procedures such as laparoscopy or laparotomy, but considering that Fitz-Hugh-Curtis syndrome is a benign condition that can be cured by oral administration of appropriate antibiotics, noninvasive diagnosis is desirable. Recently, we have experienced two cases of Fitz-Hugh-Curtis syndrome in acute phase accompanied with sharp and pleuritic right upper quadrant pain. In one case, pelvic inflammatory disease was not definite, so at first we mistook it for acute cholecystitis and reactivation of chronic hepatitis B. In the other case, Fitz-Hugh-Curtis syndrome followed the preceding, typical pelvic inflammatory disease. Both cases were diagnosed noninvasively and treated successfully by oral administration of antibiotics.