Fitz-Hugh-Curtis syndrome with disseminated intra-abdominal gonorrhoea.

Neisseria gonorrhoea continues to be implicated in a large proportion of sexually transmitted infections worldwide. Prompt recognition of infection is required to prevent further complications which include pelvic inflammatory disease and less commonly, perihepatitis which is known eponymously as Fitz-Hugh-Curtis syndrome. Third generation cephalosporins such as ceftriaxone remain effective in the treatment of gonococcal infection, however failure in initiation of appropriate antibiotic therapy in a timely manner can result in further disseminated disease. We describe an atypical case of Fitz-Hugh-Curtis syndrome presenting with multiple intra-abdominal gonococcal collections. Our case highlights the importance of a detailed sexual history in the evaluation of acute abdominal pain in at-risk patient demographics.

Fitz-Hugh-Curtis Syndrome in a Male Patient.

We report the case of a 38-year-old Middle Eastern man with intractable right upper quadrant (RUQ) abdominal pain and several emergency department visits during the last seven years, with extensive and repeated radiologic and endoscopic workups proven negative for biliary or upper gastrointestinal disease. He presented to our outpatient surgical clinic in March 2023 complaining of worsening RUQ and epigastric pain and was scheduled for a robotic cholecystectomy for presumed biliary dyskinesia following a repeat cholescintigraphy (hepatobiliary iminodiacetic acid) scan. During a cholecystectomy, extensive bilobar perihepatic adhesions were found, indicative of Fitz-Hugh-Curtis syndrome (FHCS). A thorough lysis of adhesions was performed along with a wedge liver biopsy, with subsequent histological examination showing chronic cholecystitis, perihepatic mesothelial fibrosis with mild subcapsular hepatic steatosis, and no evidence of liver fibrosis. The patient was examined in the clinic two weeks after surgery with complete resolution of symptoms. This case highlights the importance of considering FHCS in the differential diagnosis of male patients presenting with refractory RUQ abdominal pain despite a negative workup. Early recognition and prompt treatment can prevent unnecessary extensive, repeat testing and delays in intervention in these patients.

Perihepatitis as an Initial Manifestation of Systemic Lupus Erythematosus.

A 25-year-old man presented with a fever and right upper quadrant abdominal pain. Computed tomography (CT) of the abdomen revealed diffuse perihepatic capsular enhancement, suggesting perihepatitis. Although the patient was a man, Fitz-Hugh-Curtis syndrome was suspected based on the CT findings. Treatment with several antibiotics was ineffective. Urinary tract infection was ruled out due to negative urinary bacterial screening and careful history taking. He was finally diagnosed with systemic lupus erythematous (malar rash, pleuritis, positive antinuclear antibody, and positive anti-ds-DNA antibody). Perihepatitis resolved quickly with high-dose prednisolone. Perihepatitis may be the first manifestation of SLE.

Two Cases of Perihepatitis With the Liver Capsule Irritation Sign: A New Physical Examination Technique.

Perihepatitis, including Fitz-Hugh-Curtis syndrome, is an uncommon, chronic manifestation of pelvic inflammatory disease usually affecting premenopausal women. It causes right upper quadrant pain due to inflammation of the liver capsule and adhesion of the peritoneum. Since delayed diagnosis of Fitz-Hugh-Curtis syndrome can lead to infertility and other complications, physical examination findings need to be investigated to predict perihepatitis in the early stages of the disease. Here, we hypothesized that perihepatitis is characterized by increased tenderness and spontaneous pain in the right upper abdomen when the patient is placed in the left lateral recumbent position (we termed this indication the "liver capsule irritation sign"). We examined the patients physically for the presence of this liver capsule irritation sign for an early diagnosis of perihepatitis. We report the first two cases of perihepatitis due to Fitz-Hugh-Curtis syndrome in which the liver capsule irritation sign observed during the physical examination was used for diagnosis. The liver capsule irritation sign is caused by two mechanisms: first, the liver falls gravitationally into the left lateral recumbent position, which makes the liver easier to palpate; and second, the peritoneum is stretched and thus stimulated. The second mechanism is that the transverse colon running around the right upper abdomen slumps gravitationally when the patient is in the left lateral recumbent position, allowing for direct palpation of the liver. The liver capsule irritation sign can be a useful physical finding, suggestive of perihepatitis due to Fitz-Hugh-Curtis syndrome. It may also be suitable in cases of perihepatitis caused by factors other than Fitz-Hugh-Curtis syndrome.

A case of malignant peritoneal mesothelioma with a Fitz-Hugh-Curtis syndrome-like imaging finding.

Malignant peritoneal mesothelioma (MPeM) is a rare disease with a poor prognosis that develops in the mesothelial cells of the peritoneum. We encountered a 48-year-old man with no prior asbestos exposure who visited our hospital with abdominal pain. Laboratory findings showed elevated C-reactive protein of 15.5 mg/dL. Contrast-enhanced computed tomography (CT) detected a Fitz-Hugh-Curtis syndrome-like contrast effect on the liver surface and thickening of the peritoneum. Blood culture, Mycobacterium tuberculosis-specific IFN-γ release assay, Chlamydia trachomatis and Neisseria gonorrhoeae DNA testing, and antinuclear antibody were all negative. CA125 was high at 124.8 U/mL. The laparoscopy for diagnostic purposes revealed adhesions between the liver surface and peritoneum in addition to numerous small and large white nodules on the peritoneum. Biopsy of the nodules confirmed the diagnosis of epithelial-type MPeM. Treatment was initiated with combined cisplatin and pemetrexed, and CT 6 months later showed a reduced contrast effect on the liver surface and improved peritoneal thickening. A Fitz-Hugh-Curtis syndrome-like contrast effect on the liver surface on contrast-enhanced CT may help identify MPeM.

Síndrome de Stajano, Fitz-Hugh, Curtis. Descripción de un caso clínico y puesta al día de los conocimientos / Fitz-Hugh Curtis Syndrome. Description of a clinical case and knowledge update / Síndrome de Stajano, Fitz-Hugh, Curtis. Descrição de um caso clínico e atualização do conhecimento

El síndrome de Stajano, Fitz-Hugh, Curtis es una rara presentación clínica de las infecciones genitales altas, caracterizada por dolor en hipocondrio derecho, escasa sintomatología pelviana, y adherencias hepatofrénicas en forma de "cuerdas de violín". Esta rara presentación clínica lleva a frecuentes diagnósticos tardíos o erróneos, como colecistitis, apendicitis, urolitiasis o abscesos hepatofrénicos. A propósito de un caso clínico, se realiza una revisión histórica y cronológica de los conocimientos y publicaciones que se fueron sucediendo en el tiempo, de esta presentación clínica tan particular.

The Fitz-Hugh-Curtis syndrome is a rare clinical presentation of upper genital infections, characterized by pain in the right hypochondrium, few pelvic symptoms, and "violin strings" hepatophrenic adhesions. This unusual clinical presentation leads to frequent late or erroneous diagnoses, such as cholecystitis, appendicitis, urolithiasis or hepatophrenic abscesses. Based on the clinical case presented, a historical and chronological review of knowledge and publications over time, on this particular clinical presentation was conducted.

A síndrome de Stajano, Fitz-Hugh, Curtis é uma apresentação clínica rara de infecções genitais superiores, caracterizada por dor no quadrante superior direito, poucos sintomas pélvicos e aderências hepatofrênicas em forma de "cordas de violino". Esta rara apresentaçap leva a diagnósticos tardios ou errôneos, como colecistite, apendicite, urolitíase ou abscessos hepatofrênicos. Apresenta-se um caso clínico e uma revisão histórica e cronológica do conhecimento e das publicações ocorridas ao longo do tempo, desta apresentação clínica tão particular.

Asociación de síndrome de Fitz-Hugh-Curtis en fase crónica y quiste mesotelial simple en un hombre adulto. Presentación de un caso.

OBJECTIVE: Presentation of a case little reported in the literature of Fitz-Hugh-Curtis Syndrome regarding gender and its association with simple intra-abdominal mesothelial cyst. METHOD: A bibliographic source was compiled regarding the unusual presentation of the syndrome in males and its association with the simple mesothelial cyst. RESULTS: The affectation in men is infrequent, with only 10 reported cases. The simple peritoneal mesothelial cyst has an approximate incidence of 1/1,000,000. CONCLUSIONS: We are faced with an unusual presentation in terms of pathology and association, so it is important to carry out the case report.

OBJETIVO: Presentar un caso, poco reportado en la literatura, de síndrome de Fitz-Hugh-Curtis en cuanto al sexo y su asociación con quiste mesotelial simple intraabdominal. MÉTODO: Se realizó la recopilación de fuentes bibliográficas respecto a la presentación inusual del síndrome en el sexo masculino y su asociación con el quiste mesotelial simple. RESULTADOS: La afectación en varones es infrecuente, con solo 10 casos reportados. El quiste mesotelial simple peritoneal tiene una incidencia aproximada de 1/1,000,000. CONCLUSIONES: Nos encontramos ante una presentación inusual en cuanto a patología y asociación, por lo que es de relevancia realizar el reporte del caso.

18 F-FDG PET-CT in Fitz-Hugh-Curtis Syndrome.

Positron emission tomography-computed tomography (PET-CT) has demonstrated its usefulness in evaluating nonspecific abdominal and inflammatory symptoms. We report a case of young woman with chronic right upper quadrant abdominal pain. Fluorine-18 fluorodeoxyglucose PET-CT showed subhepatic hypermetabolism. Subsequent diagnostic laparoscopy confirmed the uncommon diagnosis of Fitz-Hugh-Curtis syndrome.

Fitz-Hugh-Curtis Syndrome Presenting as Perihepatic and Subcapsular Enhancement on MRI.

Fitz-Hugh-Curtis syndrome (FHCS) is a rare complication of pelvic inflammatory disease and its MRI findings remain poorly described. A 34-year-old woman was raced to our hospital with slight fever and severe right upper quadrant pain. Gadoxetic acid-enhanced magnetic resonance imaging revealed high-intensity regions in the surface and subcapsule of the right liver on T2-weighted imaging and on diffusion-weighted imaging. A definitive diagnosis of FHCS was confirmed based on high titers of serum IgA and IgG antibodies to Chlamydia trachomatis. She was treated with oral azithromycin and discharged 6 days after admission with improvement of her symptoms. To our knowledge, this report represents a valuable addition to the FHCS literature describing MRI findings in the early stage of FHCS onset.

Fitz-Hugh-Curtis syndrome without salpingitis: Should contrast-enhanced computed tomography be a routine diagnostic procedure?

Fitz-Hugh-Curtis syndrome should be suspected in sexually active young women presenting with acute right upper quadrant pain even in the absence of lower abdominal pain. The risk of radiation exposure associated with computed tomography should also be considered while making a diagnosis of abdominal pain in young patients.

Dolor en el cuadrante superior derecho en una mujer joven. Detrás de los cálculos biliares / Right upper quadrant pain in a young woman. Beyond gallstones

We present a medical image that remarks the clinical and radiological key facts that can led to the diagnosis of the relatively uncommon Fitz-Hugh-Curtis syndrome, that might be overlooked if the physician remains unaware of the referred findings. It also enhances the importance of multidisciplinary collaboration when taking care of a patient with an uncommon clinical presentation. (AU)

Diagnostic challenge of chlamydial Fitz-Hugh-Curtis syndrome and cervicitis complicated by appendicitis: Case report.

Our patient had appendicitis complicated by Chlamydia trachomatis-induced Fitz-Hugh-Curtis syndrome and cervicitis. Differential diagnosis was challenging. A 22-year-old Japanese woman was febrile and presented with vomiting and subsequent abdominal pain. She had unprotected sexual intercourse with multiple partners. She had high Alvarado score and lack of cervical motion pain, despite cervical inflammation. Noncontrast CT showed enlarged appendix. Laparoscopic appendectomy revealed acute suppurative appendicitis and perihepatic adhesion. Cervical PCR assay was positive for C. trachomatis. She remained febrile but defervesced after azithromycin therapy. Clinicians should confirm whether females with abdominal pain are sexually active in view of screening for C. trachomatis.

Fitz-Hugh-Curtis Syndrome Secondary to Postpartum Endometritis: Case Report and Literature Review.

We report a case of Fitz-Hugh-Curtis syndrome (FHCS) 1 week after an urgent cesarean section. Although its onset in the postpartum period is poorly reported in the literature, we suggest that FHCS can complicate puerperal endometritis; therefore, it should be consider in differential diagnosis in puerpera with right upper quadrant pain. Again, it can be useful to perform a contrast computed tomography that allows early diagnosis and conservative treatment.

Hepatic pseudolesion as an unusual presentation of Fitz-Hugh-Curtis syndrome.

Fitz-Hugh-Curtis Syndrome is a rare disorder manifesting as a complication associated with Pelvic Inflammatory Disease. The initial presentation generally consists of concomitant right upper quadrant and lower abdominal pain. This syndrome is characterized by inflammation of the peritoneum with the involvement of hepatic capsule and the tissues surrounding the liver. Intrahepatic involvement is rare and not yet well investigated. An accurate interpretation of Computed Tomography and Magnetic Resonance Imaging findings is missing in the literature. This report presents a case of Fitz-Hugh-Curtis Syndrome in which Computed Tomography and Magnetic Resonance Imaging showed a region of heterogeneously decreased enhancement and abnormal signal intensity within the liver mimicking a lesion.

A case of Fitz Hugh Curtis syndrome mimicking an acute abdomen.

Fitz Hugh Curtis syndrome, also known as acute perihepatitis, associates pelvic inflammatory disease with the presence of Chlamydia trachomatis or Neisseria gonorrhoeae as the main causative pathogens. Symptomatology is a nonspecific one. Right upper quadrant pain, fever, nausea and vomiting are the most commonly encountered symptoms. Imaging data are also nonspecific and often show intra-abdominal changes with no particularity. As it is difficult to suspect Fitz Hugh Curtis syndrome upon first impression, laparoscopy and direct visualization of the peritoneum and liver adhesions are needed in the diagnostic process. The specific aspect of the fibrinous strands can raise the suspicion of this disease and guide the subsequent treatment. We present the case of a 19-year-old patient with abdominal pain observed in the right upper quadrant and moderate anemia for which she was investigated in the hematology ward. The unfavorable evolution with the appearance of anemia and peritonitic acute abdomen signs required a surgical approach. The intraoperative aspects raised the suspicion of Fitz Hugh Curtis syndrome. Because of the nonspecific clinical picture as well as the insignificant imaging features, this condition can be a diagnostic and therapeutic challenge.

A Gallbladder Volvulus Presenting as Acute Cholecystitis in a Young Woman.

Gallbladder volvulus is rare and known to occur when there is a rotation of the gallbladder along the axis of the cystic vascular pedicle. Except for isolated cases reported in childhood, this disease is more frequently encountered in the elderly, especially in women. Therefore, most cases in the literature describe the clinical and radiographic features of gallbladder volvulus in this age group. In this subject, manifestations of abdominal pain are variable. Typically, right upper quadrant pain leads towards the diagnosis of cholecystitis, and diagnosis may be performed on imaging such as computed tomography (CT) scan with multi-plane CT reconstruction. However, preoperative diagnosis of gallbladder torsion remains difficult, and in most cases, especially in young women where it is rare, the clinical and radiographic features seem to differ from gallbladder torsion in the elderly. We report a case of gallbladder volvulus in a 26-year-old woman and review the clinical and radiological aspects of this disease.

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

Fitz-Hugh-Curtis syndrome (FHCS) is a rare complication of pelvic inflammatory disease. We report a case of a 21-year-old African American female presenting with inspiratory dyspnea and right upper quadrant pain found to be secondary to FHCS. The patient received antibiotic therapy, as well as testing of her sexual partners. This case demonstrates the importance of avoidance of biases such as anchoring, resulting in proper treatment and management of a rare disease entity.

Fitz-Hugh-Curtis syndrome: A cause of right upper quadrant abdominal pain. / Síndrome de Fitz-Hugh-Curtis: una causa de dolor en hipocondrio derecho.

Fitz-Hugh-Curtis syndrome (FHCS), also known as perihepatitis, is a rare complication of pelvic inflammatory disease. It has a different incidence depending on which diagnostic criteria are used. FHCS consists of inflammation of the hepatic capsule and surrounding peritoneum, without involvement of the hepatic parenchyma, due to intraperitoneal dissemination from a pelvic infection. Clinical manifestations are nonspecific and include a sudden onset of pain and discomfort in the right hypochondrium, commonly confused with other hepatobiliary, gastrointestinal or renal diseases. In recent years, Multidetector Computed Tomography has proven to be a very useful and non-invasive tool, which offers diagnostic confidence within the appropriate clinical setting. Radiological diagnosis of FHCS can avoid unnecessary surgical procedures.