Abstract
Background
Fitz-Hugh-Curtis syndrome is a rare extra-pelvic complication of genital infection
involving the perihepatic capsule. Most cases have been described in women in association
with pelvic inflammatory disease; in rare cases it has been reported in men. Because
the main symptom is acute abdominal pain, and laboratory and imaging findings are
frequently nonspecific, the differential diagnosis, considering other gastrointestinal
or renal diseases, can be difficult in the early stage of the syndrome, leading to
frequent misdiagnosis and mismanagement.
Case Report
We report a case of Fitz-Hugh-Curtis syndrome in a 26-year-old man who first presented
to the emergency department with acute abdominal pain, vomiting, and fever. Diagnosis
was possible on the basis of clinical signs of orchiepididymitis, abnormal ultrasound
findings, and specialist consultation with the Sexually Transmitted Infection Clinic.
An acute gonoccocal infection was revealed, which was complicated by a collection
of free perihepatic fluid and a subcapsular hypoechoic focal lesion. Prompt antibiotic
therapy was established, with complete resolution of the symptoms within a few days.
Why should an emergency physician be aware of this?
Awareness of the clinical presentation, imaging, and laboratory findings during the
acute phase of Fitz-Hugh-Curtis syndrome could help emergency physicians to make an
early diagnosis and to correctly manage such patients. Improved diagnostic skills
could prevent chronic complications that are especially a risk in the case of delayed
or minor genitourinary symptoms.
Keywords
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References
- Fitz-Hugh-Curtis syndrome: a diagnosis to consider in women with right upper quadrant pain.Cleve Clin J Med. 2004; 71: 233-239
- Fitz-Hugh-Curtis syndrome in a male patient: a case report and literature review.Case Rep Surg. 2012; 2012: 457272
- Clinical features of Fitz-Hugh-Curtis syndrome in the emergency department.Yonsei Med J. 2012; 53: 753-758
- Clinical outcome of Fitz-Hugh-Curtis syndrome mimicking acute biliary disease.World J Gastroenterol. 2008; 14: 6975-6980
- Diagnosis of Fitz-Hugh-Curtis syndrome by ultrasound.Eur J Obstet Gynecol Reprod Biol. 1993; 50: 159-162
- Fitz-Hugh-Curtis syndrome: CT findings of three cases.Emerg Radiol. 2007; 15: 43-46
- Laparoscopic treatment of painful perihepatic adhesions in Fitz-Hugh-Curtis syndrome.Obstet Gynecol. 1991; 78: 542-543
- A cause of adhesions in the right upper quadrant.JAMA. 1930; 94: 1221-1222
- Acute gonococcic peritonitis of the right upper quadrant in women.JAMA. 1934; 102: 2094-2096
- The Fitz-Hugh-Curtis syndrome revisited. Changing perspectives after half a century.J Reprod Med. 1985; 30: 567-582
- Acute gonococcal Fitz-Hugh-Curtis syndrome: a case report.Int J STD AIDS. 2012; 23: e39-e40
- High prevalence of Fitz-Hugh-Curtis syndrome in genital tuberculosis.Int J Gynaecol Obstet. 2007; 99: 62-63
- Workowski KA, Berman SM. Sexually transmitted diseases treatment guidelines, 2010.MMWR Recomm Rep. 2010; 59: 1-110
- Clinical Fitz-Hugh-Curtis syndrome in an adolescent. Ultrasonographic findings.Clin Pediatr (Phila). 1990; 29: 532-535
- A case of Fitz-Hugh-Curtis syndrome complicated by appendicitis conservatively treated with antibiotics.Clin Med Insights Case Rep. 2013; 6: 35-40
- Fitz-Hugh-Curtis syndrome. Radiologic manifestation.J Comput Assist Tomogr. 2003; 27: 786-791
- Sonographic features in a case of Fitz-Hugh-Curtis syndrome masquerading as malignancy.Br J Radiol. 1992; 65: 342-344
Article Info
Publication History
Published online: December 12, 2014
Accepted:
April 28,
2014
Received in revised form:
January 31,
2014
Received:
October 10,
2013
Identification
Copyright
© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
