Acute gonococcal Fitz-Hugh–Curtis syndrome: a case report

Abstract

A case of acute Fitz-Hugh-Curtis syndrome in a young woman with purulent peritonitis and acute purulent appendicitis and oophoritis is presented. Open emergency appendectomy was performed and peritoneal pus was drained. Neisseria gonorrhoeae was cultured from the peritoneal pus. The hepatic enzymes were found to be raised. The patient was successfully managed and is asymptomatic after three months follow-up. To our knowledge, this is the first case of Fitz-Hugh-Curtis syndrome reported from Kuwait.

A Case of Fitz-Hugh-Curtis Syndrome Complicated by Appendicitis Conservatively Treated with Antibiotics

“…Appendicitis is usually caused by the intraluminal overgrowth of enterobacteria, such as Escherichia coli, Peptostreptococcus and Bacteroides fragilis 19,20. However, according to previous reports, the disease can also be caused by exogenous infections with C. trachomatis and N. gonorrhoeae 13,21. In the development of perihepatitis in Fitz-Hugh-Curtis syndrome, these organisms are known to travel intraperitoneally from the genital tract via the paracolic gutters to the liver capsule 3,11.…”

“…19,20 However, according to previous reports, the disease can also be caused by exogenous infections with C. trachomatis and N. gonorrhoeae. 13,21 In the development of perihepatitis in Fitz-Hugh-Curtis syndrome, these organisms are known to travel intraperitoneally from the genital tract via the paracolic gutters to the liver capsule. 3,11 Since the organisms are more preferentially absorbed by the liver capsule than any other intra-abdominal structures, 12 perihepatitis is considered to be the most frequent intraabdominal complication of genital tract infections.…”

Acute Fitz-Hugh-Curtis Syndrome in a Man due to Gonococcal Infection

“…Successively, in 1985, C. trachomatis was recognized as the most frequent pathogen isolated in cases of FHCS (10). However, cases secondary to N. gonorrhoeae infection are still present and rare cases after genital tuberculosis have been described recently (11,12).…”

“…Nucleic acids amplification techniques are currently considered the gold standard for diagnosis of C. trachomatis and N. gonorrhoeae infections, due to their high sensitivity and specificity (13). For this purpose, urine or genital specimens are the best choice, but analysis of pelvic free fluid has also been attempted in selected cases (2,11). Culture or direct identification can also be used to recognize N. gonorrhoeae, but serology for C. trachomatis is not advisable.…”

Gonococcal pelviperitonitis: a diagnostic challenge

“…De acuerdo con Baba y col 7 , citado por Joshi y col 8 , la infección por N. gonorrhoeae se encuentra infradiagnosticada debido a que es asintomáticas hasta en el 50% de los casos; incluso la peritonitis gonocócica, sin afectación de la cápsula hepática, se diagnostica con poca frecuencia 7 . A pesar de las técnicas de amplificación de ácidos nucleicos (reacción en cadena de la polimerasa, PCR) que en los últimos años se están utilizando para la detección de N. gonorrhoeae, el patrón oro (gold standard) para el diagnóstico sigue siendo el aislamiento en medio de cultivo de este diplococo Gram negativo, donde puede hacerse estudio de sensibilidad.…”